{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:46:13Z","timestamp":1787028373838,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Although electronic cigarettes have been banned in Brazil since 2009, their use is increasing, particularly among youth. We conducted a biomarker-based study to profile exclusive e-cigarette users in S\u00e3o Paulo and to examine the associations of e-cigarette use with salivary nicotine and cotinine levels. A population-based, cross-sectional study was conducted between April and September 2024 in six municipalities in S\u00e3o Paulo, Brazil. Randomly selected participants who reported exclusive use of electronic cigarettes completed a questionnaire and provided oral fluid samples for the determination of their nicotine and cotinine concentrations using LC-MS\/MS. The cohort consisted of N = 417 participants. Significant associations were found between nicotine and cotinine concentrations and variables such as knowledge of nicotine content and product type. Addiction status significantly influenced the nicotine and cotinine concentrations, as well as smoking history, last consumption, recharge\/purchase frequency, and consumption duration (all p &lt; 0.001). Participants who perceived themselves to have a moderate or severe addiction exhibited higher nicotine and cotinine concentrations compared with those who did not perceive that they had an addiction (p &lt; 0.001). Most participants were young, predominantly White, and highly educated and earned higher incomes. The findings reveal a correlation between perceived nicotine dependence and salivary nicotine and cotinine concentrations, underscoring the physiological and behavioral markers of electronic cigarette addiction. High salivary concentrations of nicotine appear to be independent of duration of e-cigarette use, smoking history, and age. These findings underscore the urgent need for surveillance and public health interventions, even in jurisdictions where these products remain illegal. The study limitations include its cross-sectional design and potential selection bias due to convenience sampling.<\/jats:p>","DOI":"10.3390\/ijerph22060960","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T05:17:42Z","timestamp":1750396662000},"page":"960","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Nicotine Dependence in a Banned Market: Biomarker Evidence from E-Cigarette Users in S\u00e3o Paulo, Brazil"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-8516","authenticated-orcid":false,"given":"Jaqueline Ribeiro","family":"Scholz","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine Cristine","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Secretaria de Estado da Sa\u00fade, Vigil\u00e2ncia Sanit\u00e1ria Estadual, Sao Paulo 01246-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4581-7685","authenticated-orcid":false,"given":"Juliana","family":"Takitane","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao\u2014LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele Mayumi","family":"Sinagawa","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao\u2014LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9621-2291","authenticated-orcid":false,"given":"Jo\u00e3o Mauricio","family":"Castaldelli-Maia","sequence":"additional","affiliation":[{"name":"Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Filonzi","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao\u2014LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3049-3792","authenticated-orcid":false,"given":"Rodrigo Alves","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao\u2014LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Vinicius","family":"Marques","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Nagamine","family":"Lima","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Fernanda Lasso","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5740-9564","authenticated-orcid":false,"given":"Sara","family":"Ziotti","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-1290","authenticated-orcid":false,"given":"Vilma","family":"Leyton","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao\u2014LIM40, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05508-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Megid","sequence":"additional","affiliation":[{"name":"Secretaria de Estado da Sa\u00fade, Vigil\u00e2ncia Sanit\u00e1ria Estadual, Sao Paulo 01246-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"ref_1","unstructured":"(2025, January 12). 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