Background: In recent years, electronic cigarettes (e-cigarettes) have generated considerable interest and debate on the implications for tobacco control and public health. Although the rapid growth of e-cigarettes is global, at present, little is known about awareness and use. This paper presents self-reported awareness, trial and current use of e-cigarettes in 10 countries surveyed between 2009 and 2013; for six of these countries, we present the first data on e-cigarettes from probability samples of adult smokers. Methods: A cross-sectional analysis of probability samples of adult (≥ 18 years) current and former smokers participating in the International Tobacco Control (ITC) surveys from 10 countries. Surveys were administered either via phone, face-to-face interviews, or the web. Survey questions included sociodemographic and smoking-related variables, and questions about e-cigarette awareness, trial and current use. Results: There was considerable cross-country variation by year of data collection and for awareness of e-cigarettes (Netherlands (2013: 88%), Republic of Korea (2010: 79%), United States (2010: 73%), Australia (2013: 66%), Malaysia (2011: 62%), United Kingdom (2010: 54%), Canada (2010: 40%), Brazil (2013: 35%), Mexico (2012: 34%), and China (2009: 31%)), in self-reports of ever having tried e-cigarettes (Australia, (20%), Malaysia (19%), Netherlands (18%), United States (15%), Republic of Korea (11%), United Kingdom (10%), Mexico (4%), Canada (4%), Brazil (3%), and China (2%)), and in current use (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%)). Conclusions: The cross-country variability in awareness, trial, and current use of e-cigarettes is likely due to a confluence of country-specific market factors, tobacco control policies and regulations (e.g., the legal status of e-cigarettes and nicotine), and the survey timing along the trajectory of e-cigarette awareness and trial/use in each country. These ITC results constitute an important snapshot of an early stage of what appears to be a rapid progression of global e-cigarette use.

ResumoEmbora a ciência tenha demonstrado de forma inequívoca os graves prejuízos decorrentes do consumo do tabaco, seu uso continua a aumentar globalmente, à custa do cresci mento do consumo em países em desenvolvimento. A ausência de medidas abrangentes para controle do tabagismo nesses países torna-os vulneráveis às agressivas estratégias de marketing das grandes companhias transnacionais de tabaco. Mesmo sendo o segundo maior produtor mundial de tabaco e o maior exportador de tabaco em folhas, o Brasil tem conseguido escapar dessa tendência. Há cerca de 15 anos, o Ministério da Saúde, por meio do Instituto Nacional de Câncer, vem articulando, nacionalmente, ações de natureza intersetorial e de abrangência nacional, junto a outros setores do governo, com a parceria das secretarias estaduais e municipais de Saúde e de vários setores da sociedade civil organizada. Nesse trabalho procurou-se descrever a lógica do programa e analisar alguns dos avanços alcançados e alguns dos desafi os ainda existentes no âmbito do controle do tabagismo no Brasil. E principalmente, procurou-se evidenciar a importância de diferentes medidas intersetoriais para controlar as várias determinantes sociais e econômicas da expansão do consumo de tabaco, com destaque para as estratégias das grandes companhias de tabaco no Brasil, que a cada dia tornam-se mais agressivas e sofi sticadas em resposta aos evidentes efeitos do Programa Nacional de Controle do Tabagismo na redução do consumo.Palavras chave: Controle do tabagismo, tabaco, tabagismo, cigarro, Convenção Quadro para Controle do Tabaco. AbstractThough science has unequivocally demonstrated the devastating effects of tobacco consumption, it has been increasing mainly in developing countries. The lack of comprehensive measures for tobacco control in these countries makes them vulnerable to the aggressive marketing strategies of large transnational tobacco companies. Despite being the second greatest producer of tobacco in the world and the leader in exports of raw tobacco leaves, Brazil has escaped from the frightening trend of increasing

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Previous studies have shown that the most threatening and arousing pictures prompt the greatest evidence of defensive activation. Emotional ratings of Brazilian warning pictures described them as unpleasant but moderately arousing. To intensify avoidance of the packages, future graphic warnings should therefore generate more arousal. The ratings for the Brazilian warning pictures indicated that, except for those depicting people smoking, judgements by smokers and non-smokers were similar, suggesting a potential applicability in both prevention and cessation. Smoking cues, however, should be avoided.

The article presents a review of Brazilian tobacco control policies from 1986 to 2016, based on contributions from political economics and analyses of public policies. The institutionalization of tobacco control in the country was marked by more general changes in health policies and by specific events related to the theme. Brazil's international leadership role, a robust National Tobacco Control Policy, the role of civil society and the media all contributed to the success of tobacco control in this country. However, challenges remain regarding crop diversification in tobacco farms, illegal trade in cigarettes, pressure from the tobacco industry and the sustainability of the Policy. This study reinforces the importance of bearing in mind the relationship between the domestic and international context, and the articulation between different governmental and non-governmental sectors and players when analyzing complex health policies. Continuity and consolidation of the tobacco control policies depend on the persistence of a broad institutional framework to guide the State's actions in social protection, in accordance with Unified Healthcare System guidelines.