Nicotine Dependence in a Banned Market: Biomarker Evidence from E-Cigarette Users in São Paulo, Brazil Jaqueline Ribeiro Scholz, Elaine Cristine D’Amico, Juliana Takitane, Daniele Mayumi Sinagawa, João Mauricio Castaldelli-Maia, Marcelo Filonzi dos Santos, Rodrigo Alves de Oliveira, Guilherme Vinicius Marques, Eric Nagamine Lima, Diana Fernanda Lasso Rodriguez, Sara Ziotti, Vilma Leyton, Maria Cristina Megid International Journal of Environmental Research and Public Health, 2025 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 São 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 São 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 < 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 < 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.
Drink driving and speeding in Sao Paulo, Brazil: Empirical cross-sectional study (2015-2018) Gabriel Andreuccetti, Vilma Leyton, Heráclito Barbosa Carvalho, Daniele M Sinagawa, Henrique S Bombana, Julio C Ponce, Katharine A Allen, Andres I Vecino-Ortiz, Adnan A Hyder BMJ Open, 2019 ObjectivesTo evaluate the prevalence of drink driving and speeding during 2015–2018 in Sao Paulo, Brazil.DesignCross-sectional observational study.SettingRoads representing the five main regions of the city of Sao Paulo in Brazil, one of the world’s largest urban areas.ParticipantsDrivers (N=10 294) stopped at routine roadside breath testing checkpoints and those driving in selected roads for speeding measurement (N=414 664).Primary and secondary outcome measuresMicrowave radar guns were used to measure the speed of vehicles, while the prevalence of drivers under the influence of alcohol was observed in police checkpoints. Data were collected during three consecutive years (2016–2018) following a baseline study established in 2015 using a city-level representative sample of observational data representing all days of the week.ResultsAlcohol-related fatalities kept at a constantly high percentage, with 39% of road traffic deaths involving alcohol in 2016. Drivers testing above the legal breath alcohol concentration limit showed a decreasing trend, from 4.1% (95% CI 2.9% to 5.5%) at baseline to 0.6% (95% CI 0.2% to 1.2%) in the end of 2018 (p<0.001); however, more than half of drivers refused breath tests at checkpoints despite steep legal penalties. The prevalence of speeding among all vehicles decreased from 8.1% (95% CI 7.9% to 8.2%) to 4.9% (95% CI 4.7% to 5.1%) by the end of 2016 (p<0.001), but then increased again to 13.5% (95% CI 13.2% to 13.9%) at the end of the study period (p<0.001).ConclusionsDrink driving rates have reduced, likely due to an increase in drivers refusing breath alcohol tests, while speeding rates have increased significantly by the end of the study period, particularly among motorcycles. Future strategies aiming at reducing road traffic injuries in the major Brazilian city should tailor drink driving and speeding enforcement based on the new evidence provided here.
Trends in the use of psychoactive substances by truck drivers in São Paulo State, Brazil: A time-series cross sectional roadside survey (2009–2016) Vilma Leyton, Henrique Silva Bombana, Juliana Gallottini Magalhães, Helena Nascimento Panizza, Daniele Mayumi Sinagawa, Juliana Takitane, Heraclito Barbosa de Carvalho, Gabriel Andreuccetti, Mauricio Yonamine, Hallvard Gjerde, Daniel Romero Muñoz Traffic Injury Prevention, 2019 OBJECTIVE: Truck drivers represent a group that is susceptible to the use of stimulant substances to reduce the symptoms of fatigue, which may be caused by a stressful and exhausting work environment. The use of psychoactive substances may increase the risk for involvement in road traffic crashes. Previous studies have demonstrated that amphetamine, cocaine, and cannabis are the 3 main drugs used by Brazilian truck drivers. We studied the prevalence of amphetamine, benzoylecgonine (indicating use of cocaine), and Δ-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH; indicating use of cannabis) in urine samples from truck drivers in the state of São Paulo, Brazil, using the same methodology during 8 years (2009-2016). METHODS: Samples were collected during a health program supported by the Federal Highway Police. Toxicological analyses were performed using immunoassays and gas chromatography-mass spectrometry. RESULTS: The total prevalence of illicit drugs was 7.8%. Benzoylecgonine was the most prevalent substance (3.6%), followed by amphetamine (3.4%) and THC-COOH (1.6%). We found the highest drug prevalence in 2010 (11.3%) and the lowest in 2011 (6.1%). We could detect a slight change in the pattern of stimulant use: until 2010, amphetamine was the most prevalent substance; however, in 2011 benzoylecgonine became the most frequently detected substance. This lasted until 2015, probably due to changes in Brazilian legislation regarding appetite suppressants; the most common one is metabolized to amphetamine. CONCLUSION: These data show that the use of psychoactive substances by truck drivers in Brazil did not decrease during the study period. This reinforces the need for further preventive measures to reduce drug use among drivers, which could lead to a decrease in traffic crashes in Brazil.
Drinking and driving in Brazil: same problem, same loophole Gabriel Andreuccetti, Vilma Leyton, Heraclito Barbosa de Carvalho, Daniele Mayumi Sinagawa, Katharine A. Allen, Adnan A. Hyder Addiction Abingdon England, 2016 It has been nearly two decades since Brazil implemented its first drinking and driving law, when driving with a blood alcohol concentration (BAC) above 0.06% was considered a ‘driving under the influence’ (DUI) offence 1. Since the law's inception the legislation has undergone numerous modifications, including the reduction of the BAC limit to the current zero tolerance law: a blood alcohol level above 0.01% is deemed an administrative offense with a fine and short licence suspension, while a criminal offence with a higher fine, criminal record and possible jail time, occurs when a driver has a BAC above 0.06% 2. Studies conducted during this period have supported that both establishing a BAC limit for drivers, as well as lowering it, had a positive effect on road traffic injuries and the proportion of DUI reports 3-5. However, fundamental data such as BACs from injured drivers are still not collected systematically at the national level 6, leaving a large gap where strategies are being implemented without rigorous evaluation of their effectiveness 7. Denying a breath test during a DUI investigation under law 12 760/2012 2 is penalized only by an administrative penalty (fine and temporary driver's licence suspension), while criminal sanctions that include jail time and harsher administrative sanctions for drunk drivers are usually applied only if someone is detected with a BAC of 0.06% or higher. In other words, refusing a breath test under a DUI investigation will result in a modest fine (around US$ 500), but these penalties are minimal compared to undergoing a criminal prosecution that might result in imprisonment. Practitioners in the road safety field are frustrated by these legislative loopholes. Brazilian researchers are also pessimistic about finding an immediate solution to impaired driving. Without basic data on levels of impaired driving being made available, Brazil has become a true ‘social experiment’ in terms of understanding the deterrence effects expected from enforcing DUI laws in developing regions. Recent data collected from drivers stopped at random DUI checkpoints in the biggest city in Brazil might highlight further the nature of this public health issue that currently ranks among the deadliest in low- to middle-income countries. Between July and August 2015, we observed 1057 drivers who were stopped by routine random DUI checkpoints in six different locations in São Paulo from Friday to Sunday following an international standard data collection procedure 8, 9. We collected information on drivers who were stopped randomly and submitted to alcohol breath tests. Of all drivers, 14.1% screened positive for any alcohol, which was a higher prevalence than results from previous studies in Brazil 10. Among these alcohol-positive drivers, almost 60% refused additional testing to determine their BAC. Many developed countries have halved their road traffic deaths involving alcohol by increasing the chance of offenders being caught by police while driving under the influence 11. Brazil has joined the fight to reduce the overwhelming number of almost 40 000 road traffic deaths a year; however, the effectiveness of these strategies needs to be measured. This work was supported by a grant provided by Bloomberg Philanthropies as part of the Bloomberg Initiative for Global Road Safety. G.A. is currently supported by São Paulo Research Foundation (FAPESP) and CAPES Foundation from Brazil (#2014/01054-0). All other authors have no conflicts of interest to declare. All the opinions, conclusions and recommendations expressed in this material are the responsibility of the authors and do not necessarily reflect the point of view from FAPESP and CAPES.
Association Between Travel Length and Drug Use Among Brazilian Truck Drivers Daniele Mayumi Sinagawa, Heráclito Barbosa De Carvalho, Gabriel Andreuccetti, Natanael Vitoriano Do Prado, Keziah Cristina Barbosa Gruber De Oliveira, Mauricio Yonamine, Daniel Romero Muñoz, Hallvard Gjerde, Vilma Leyton Traffic Injury Prevention, 2015 OBJECTIVE: To investigate whether the use of the stimulants amphetamines and cocaine by truck drivers in Brazil was related to travel length. METHODS: Truck drivers were randomly stopped by the Federal Highway Police on interstate roads in Sao Paulo State during morning hours from 2008 to 2011 and invited to participate in the project "Comandos de Saúde nas Rodovias" (Health Commands on the Roads). Participants were asked about the use of drugs, travel distance, and age, and gender was recorded. Samples of urine were collected and analyzed for amphetamine, benzoylecgonine (a metabolite of cocaine), and carboxytetrahydrocannabinol (THC-COOH; a metabolite of cannabis) by immunological screening and quantification by gas chromatography-mass spectroscopy. RESULTS: Current use of amphetamine, cocaine, and cannabis was reported by 5.7%, 0.7%, and 0.3% of the truck drivers, respectively. Amphetamine, benzoylecgonine, and THC-COOH were found in urine samples from 5.4%, 2.6,% and in 1.0% of the drivers, respectively. There was a significant association between the positive cases for amphetamine and reported travel length; 9.9% of urine samples from drivers who reported travel length of more than 270 km were positive for amphetamine, and 10.9% of those drivers reported current use of amphetamines. In most cases, appetite suppressants containing amphetamines had been used, but the purpose was most often to stay awake and alert while driving. Truck drivers with travel length of more than 270 km had significantly higher odds ratio (OR) for having a urine sample that was positive for amphetamine when adjusted for age as confounding factor (OR = 9.41, 95% confidence interval [CI], 3.97-22.26). No significant association was found between the use of cocaine or cannabis and travel length. CONCLUSION: Truck drivers who reported driving more than 270 km had significantly higher frequencies of urine samples positive for amphetamine and reported significantly more frequent current use of amphetamines than those who reported shorter driving distances.
Persistent amphetamine consumption by truck drivers in São Paulo State, Brazil, despite the ban on production, prescription, and use Lúcio Garcia de Oliveira, Ligia Goes Endo, Daniele Mayumi Sinagawa, Maurício Yonamine, Daniel Romero Munoz, Vilma Leyton Cadernos De Saude Publica, 2013 O uso de anfetaminas por motoristas de caminhão com fins ocupacionais é amplamente reconhecido, entretanto, no mês de outubro de 2011, sua produção e uso foram proibidos através de uma resolução da Agência Nacional de Vigilância Sanitária (ANVISA). O objetivo deste estudo foi identificar o uso de anfetaminas entre motoristas de caminhão após a implementação da referida resolução. Uma amostra de conveniência de 427 motoristas de caminhão foi abordada em rodovias do Estado de São Paulo, Brasil, durante o ano de 2012. Os participantes foram solicitados a responder um instrumento de pesquisa estruturado, assim como fornecer uma amostra de urina para avaliar o uso recente de anfetaminas através de análise toxicológica. Entre os motoristas avaliados, 7% fizeram uso recente de alguma substância ilícita, dos quais 2,7% usaram anfetaminas. Aparte a periculosidade associada ao uso de anfetaminas, assim como a despeito da resolução que o regulamenta, esse uso continua entre os motoristas de caminhão. Assim, sugere-se que as autoridades competentes fiscalizem a posse, assim como o uso de anfetaminas no contexto do trânsito.
