Users’ knowledge and perceptions concerning the Brazilian legislation on electronic nicotine delivery systems: a qualitative study

Abstract

In Brazil, since 2009, the commercialization and advertising of electronic nicotine delivery systems’(ENDS) have been prohibited. Recently, RDC-ANVISA N. 855/2024 was published, which maintained the prohibitions, based on current robust scientific evidence. This study sought to understand users’ knowledge and perceptions about the Brazilian legislation on ENDS and how it impacts their use behaviors. This is an exploratory qualitative research, with in-depth interviews, using content analysis of 3 thematic axes: “Commercialization”, “Advertising/publicity”, “Environments of use”. Participants were aware of sales prohibition, reporting legislation had hindered purchases in physical-stores, but cited internet as a prime space for access ENDS. They demonstrated that they were aware of the prohibition of advertising/publicity, but point to digital influencers as central agents in the construction of their perceptions about ENDS. They were aware of the prohibition of smoking in collective environments, but reported that using ENDS is possible because it does not cause “social nuisance”, since lack of unpleasant smoke/smell. Thus, we show that, although the legislation creates obstacles to access/use of ENDS, in practice, such rules are “disregarded/circumvented”. In conclusion, the “social acceptability” of ENDS can renormalize smoking, and it is crucial to carry out information campaigns about risks/harms of ENDS and more effective surveillance.