Este artigo reúne mais de 550 estudos científicos, relatórios técnicos e documentos institucionais relacionados à Redução dos Danos do Tabagismo (RDT). Esse conjunto de evidências foi compilado a partir de pesquisas conduzidas por universidades, centros acadêmicos, agências reguladoras, fabricantes, órgãos de saúde pública e instituições científicas de diversos países.

É fundamental deixar claro desde o início: apesar de extensa, essa lista representa apenas uma pequena parcela do volume total de evidências científicas já existente sobre o tema. Hoje, há milhares de estudos publicados analisando produtos de nicotina sem combustão — como cigarros eletrônicos, produtos de tabaco aquecido, sachês de nicotina oral e terapias de reposição de nicotina — sob perspectivas que incluem toxicologia, epidemiologia, biomarcadores de risco, cessação do tabagismo, comportamento do consumidor, saúde pública e políticas regulatórias.

Ainda assim, persiste no debate público a narrativa de que “não há estudos suficientes” para afirmar que esses produtos apresentam menor risco em comparação ao cigarro tradicional. Essa afirmação não resiste a uma análise honesta da literatura científica disponível.

A falsa ideia de “evidência insuficiente”

Um dos pilares do discurso contrário à Redução dos Danos do Tabagismo é a alegação de que as evidências seriam escassas, inconclusivas ou prematuras. No entanto, os estudos reunidos neste documento — provenientes de fontes como The Lancet, National Academies of Sciences, Royal College of Physicians, Public Health England, FDA, CDC, NICE e outras instituições de referência — apontam de forma consistente para um mesmo ponto central:

O principal responsável pelos danos do tabagismo é a combustão do tabaco, e não a nicotina em si.

Ao eliminar a queima, produtos sem fumaça reduzem drasticamente a exposição a milhares de substâncias tóxicas e carcinogênicas presentes na fumaça do cigarro. Essa redução não é teórica: ela é observada de maneira objetiva em estudos que analisam emissões químicas, biomarcadores de exposição e indicadores fisiológicos de risco.

Em fumantes que migram total ou majoritariamente para produtos sem combustão, os níveis de diversos marcadores associados a câncer, doenças cardiovasculares e respiratórias caem de forma significativa, muitas vezes se aproximando dos níveis observados em pessoas que não fumam.

Produtos de menor risco como política de saúde pública

Os estudos aqui listados também demonstram que a Redução dos Danos do Tabagismo não deve ser vista apenas como uma escolha individual, mas como uma estratégia eficaz de saúde pública.

Experiências internacionais mostram que políticas baseadas em acesso, informação correta e diferenciação de risco entre produtos:

• Aceleram a redução da prevalência do tabagismo, como observado em países como Suécia, Reino Unido, Japão e Nova Zelândia;
• Ajudam fumantes que não conseguem ou não desejam parar abruptamente a abandonar o cigarro, substituindo-o por alternativas de menor risco;
• Reduzem de forma substancial os danos associados ao consumo de nicotina por meio da combustão, com impactos positivos mensuráveis em saúde populacional.

Ignorar ou suprimir essas evidências não elimina o consumo de nicotina, apenas mantém milhões de pessoas presas ao produto mais letal disponível no mercado: o cigarro convencional.

Como este artigo está organizado

Abaixo você encontrará mais de 550 estudos organizados de forma categorizada por macrotema. O objetivo é permitir que qualquer pessoa — jornalista, pesquisador, profissional de saúde, legislador ou cidadão interessado — possa consultar diretamente as fontes científicas e formar sua própria opinião com base em evidências.

Essa lista inclui tanto estudos independentes, conduzidos por universidades, centros acadêmicos, órgãos públicos e organizações sem qualquer vínculo com a indústria fabricante de cigarros, quanto estudos produzidos ou financiados por fabricantes de produtos de nicotina. Essa inclusão não é acidental nem ingênua, mas reflete uma compreensão básica do funcionamento da ciência contemporânea.

Nos últimos anos, fabricantes cigarros passaram a também comercializar produtos de nicotina sem combustão, investindo volumes significativos de recursos em pesquisa científica, incluindo estudos toxicológicos, clínicos, epidemiológicos e de biomarcadores. Esses estudos são, em grande parte, publicados em revistas científicas revisadas por pares, com dados divulgados publicamente, permitindo escrutínio independente, replicação e contestação por outros pesquisadores.

É inegável que um trabalho financiado por quem fabrica os produtos alvo de uma pesquisa científica caracteriza um claro conflito de interesse, que deve sempre ser declarado e considerado de forma crítica. No entanto, isso não pode invalidar automaticamente um estudo, seus métodos ou resultados. A validade científica de uma pesquisa é determinada pela qualidade metodológica, transparência dos dados, reprodutibilidade e consistência das conclusões, e não exclusivamente pela origem do financiamento.

Opositores da Redução dos Danos do Tabagismo adotam uma postura alarmista, focada quase exclusivamente em atacar a indústria fabricante e a origem do financiamento dessas pesquisas, sem confrontar os dados apresentados, sem refutar metodologias ou sequer demonstrar evidências científicas contrárias de igual robustez. Esse tipo de abordagem desloca o debate do campo científico para o campo ideológico, o que empobrece a análise e não contribui para a proteção da saúde pública.

Ainda mais importante, essa tática entra em conflito com o próprio marco regulatório internacional estabelecido pela Organização Mundial da Saúde, que no relatória da CQCT – Convenção-Quadro para Controle do Tabaco, apresentado na 6ª Conferência das Partes, a OMS afirma que a regulamentação dos Sistemas Eletrônicos de Entrega de Nicotina (ENDS) é necessária para permitir a avaliação científica de seus efeitos. No mesmo documento, a CQCT reconhece que a responsabilidade primária por comprovar cientificamente as alegações sobre esses produtos recai sobre seus fabricantes.

A ciência não avança por exclusão seletiva de evidências com base em preferências morais ou políticas, mas pela avaliação crítica dos dados disponíveis, independentemente de quem os produziu. Cabe à comunidade científica — e não a discursos falaciosos — analisar resultados, identificar limitações, exigir transparência e verificar se as conclusões se sustentam diante do conjunto mais amplo de evidências.

Até o momento, uma parcela significativa das pesquisas financiadas pela indústria tem apresentado resultados consistentes com estudos independentes de alta qualidade, especialmente no que se refere à redução substancial da exposição a substâncias tóxicas quando a combustão é eliminada. Ignorar esses dados não os torna falsos; apenas impede que sejam corretamente avaliados.

O problema do tabagismo e a evolução das respostas em saúde pública

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Denlinger-Apte, R.L., et al., Risk perceptions of low nicotine cigarettes and alternative nicotine products across priority smoking populations. Int J Environ Res Public Health, 2021. 18(10):5311. DOI: 10.3390/ijerph18105311

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Wackowski, O.A., et al., Smokers’ sources of e-cigarette awareness and risk information. Prev Med Rep, 2015. 2: p. 906-910. DOI: 10.1016/j.pmedr.2015.10.006

Perspectivas sobre ciência e redução de danos

Action on Smoking and Health (ASH), Use of e-cigarettes (vapes) among adults in Great Britain. 2024. https://ash.org.uk/uploads/Use-of-vapes-among-adults-in-Great-Britain-2024.pdf.

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Perspectivas diversas sobre redução de danos do tabagismo

Gottlieb, S. and Zeller, M., A nicotine-focused framework for public health. N Engl J Med, 2017. 377(12): p. 1111-1114. DOI: 10.1056/NEJMp1707409

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Nicotina, produtos sem fumaça e padrões reais de uso

Nicotina: o que a ciência realmente mostra

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Kim, M. M., et al., “Study title: A systematic review of RCTs to examine the risk of adverse cardiovascular events with nicotine use” Front Cardiovasc Med, 2023. 10:1111673. DOI: 10.3389/fcvm.2023.1111673

U.S. Food & Drug Administration, Nicotine is Why Tobacco Products are Addictive. https://www.fda.gov/tobacco-products/healtheffects-tobacco-use/nicotine-why-tobacco-products-are-addictive (1 agosto 2024)

Moldoveanu, S.C., et al., Nicotine analysis in several non-tobacco plant materials. Contrib Tob Nicotine Res, 2016. 27(2): p. 54-59. DOI: 10.1515/cttr-2016-0008

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Jenkins, R.A., et al., Mainstream and sidestream smoke. In The chemistry of environmental tobacco smoke: composition and measurement (2nd ed.), CRC Press, 2000. p 49-75. DOI: 10.1201/9781482278651

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Office of Health Improvement and Disparities, Smoking and tobacco: applying All Our Health. Gov. UK, 2022. https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health

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Risco relativo entre produtos sem fumaça e cigarros convencionais

Doll, R., et al., Mortality in relation to smoking: 50 years’ observations on male British doctors. Br Med J, 2004. 328(7455):1519. DOI: 10.1136/bmj.38142.554479.AE

Nutt, D.J., et al., Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res, 2014. 20(5): p. 218-225. DOI: 10.1159/000360220

AP News, Insider Q&A: FDA official on vaping’s “promise or peril”. 2022. https://apnews.com/article/science-health-public-tobaccoindustry-regulation-6af0d635d7859bab914cc249ef43b6e2

McNeill, A., et al., E-cigarettes: an evidence update. Public Health England, 2015. https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update (8 agosto 2024)

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Royal Australian College of General Practitioners (RACGP), Supporting smoking cessation: A guide for health professionals. 2014. https://extranet.who.int/ncdccs/Data/AUS_D1bib_Supporting%20smoking%20cessation.pdf

Chen, J., et al., A comparative health risk assessment of electronic cigarettes and conventional cigarettes. Int J Environ Res Public Health, 2017. 14(4): 382. DOI: 10.3390/ijerph14040382

Eaton, D.L., et al., Public Health Consequences of E-Cigarettes. National Academies Press, 2018. DOI: 10.17226/24952

Mallock, N., et al., Levels of selected analytes in the emissions of “heat not burn” tobacco products that are relevant to assess human health risks. Arch Toxicol, 2018. 92(6): p. 2145-2149. DOI: 10.1007/s00204-018-2215-y

Caponnetto, P., et al., Carbon monoxide levels after inhalation from new generation heated tobacco products. Respir Res, 2018. 19:164. DOI: 10.1186/s12931-018-0867-z

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Benowitz, N.L., et al., Clinical Pharmacology of Electronic Nicotine Delivery Systems (ENDS): Implications for Benefits and Risks in the Promotion of the Combusted Tobacco Endgame. J Clin Pharmacol, 2021. 61: p. S18-S36. DOI: 10.1002/jcph.1915

Snowdon, C., et al., Vaping Works. International Best Practises: United Kingdom, France, Canada and New Zealand. Property Rights Alliance, 2021. https://www.propertyrightsalliance.org/wp-content/uploads/PRA_VapingWorks.pdf

Hidayat, S. and Alayyannur, P.A., The content of harmful and potentially harmful constituents in heated tobacco product: Systematic review. J Drug Deliv Ther, 2021. 11(3-S): p. 111-120. DOI: 10.22270/jddt.v11i3-S.4830

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Bundesinstitut für Risikobewertung (BfR). Health Risk Assessment of Nicotine Pouches: Updated BfR Opinion No. 023/2022. 2022. DOI: 10.17590/20220204-105615

Hu, H., et al., Heated tobacco products and circulating high-density lipoprotein cholesterol concentrations. Sci Rep, 2022. 12(1):17385. DOI: 10.1038/s41598-022-22337-3

Hartmann-Boyce, J., et al. Biomarkers of potential harm in people switching from smoking tobacco to exclusive e-cigarette use, dual use or abstinence: secondary analysis of Cochrane systematic review of trials of e-cigarettes for smoking cessation. Addiction, 2023. 118(3): p. 539-545. DOI: 10.1111/add.16063

PMI Science, Greek Ministry of Health approves differentiated health claims for heated tobacco products, including THS. 2023. https://www.pmiscience.com/en/smoke-free/tobacco-regulation/greece-approves-health-claims-heated-tobacco/ (24 julho 2024)

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U.S. Centers for Disease Control and Prevention (CDC), Health Effects of Vaping. 2024. https://www.cdc.gov/tobacco/e-cigarettes/health-effects.html (24 julho 2024)

Auer, R., et al., Electronic Nicotine-Delivery Systems for Smoking Cessation. N Engl J Med, 2024. 390(7): p. 601-610. DOI: 10.1056/NEJMoa2308815

Beaglehole, R., and Bonita, R., Harnessing tobacco harm reduction. Lancet, 2024. 403(10426): p. 512-514. DOI: 10.1016/S0140-6736(24)00140-5

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O debate científico sobre o efeito “porta de entrada”

Vlaams Instituut Gezond Leven, Alle jongeren aan de e-sigaret? https://www.gezondleven.be/nieuws/alle-jongeren-aan-de-esigaret (1 agosto 2024)

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Khouja, J.N., et al., Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis. Tob Control, 2021. 30(1): p. 8-15. DOI: 10.1136/tobaccocontrol-2019-055433

Vlaams Instituut Gezond Leven, Alle jongeren aan de e-sigaret? Tijd voor een diepgaande analyse van het vapegedrag van Vlaamse jongeren. https://www.gezondleven.be/files/tabak/Rapport-e-sigaret-en-jongeren.pdf

Cancer Research UK, Vaping: what we know and what we don’t about e-cigarettes. 2021. https://news.cancerresearchuk.org/2021/04/26/ecigarettes-what-we-know-and-what-we-dont/ (24 julho 2024)

Qual a importância dos sabores nos produtos sem fumaça e nas estratégias de RDT?

Mok, Y., et al., Associations between E-cigarette use and E-cigarette flavors with cigarette smoking quit attempts and quit success: evidence from a US Large, Nationally Representative 2018–2019 Survey. Nicotine Tob Res, 2023. 25(3): p. 541-552. DOI: 10.1093/ntr/ntac241

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Li, L., et al., How does the use of flavored nicotine vaping products relate to progression toward quitting smoking? Findings from the 2016 and 2018 ITC 4CV surveys. Nicotine Tob Res, 2021. 23(9): p. 1490-1497. DOI: 10.1093/ntr/ntab033

Action on Smoking Health (ASH), Use of e-cigarettes (vapes) among adults in Great Britain. 2023. https://ash.org.uk/uploads/Use-of-e-cigarettes-among-adults-in-Great-Britain-2023.pdf

Russell C., et al., Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J, 2018. 15:33. DOI: 10.1186/s12954-018-0238-6

Há relação entre a disponibilidade de produtos sem fumaça e a queda do tabagismo?

Snowdon, C., et al., Vaping Works. International Best Practises: United Kingdom, France, Canada and New Zealand. Property Rights Alliance, 2021. https://www.propertyrightsalliance.org/wp-content/uploads/PRA_VapingWorks.pdf

Tobacco Free Life, History of Tobacco. https://tobaccofreelife.org/tobacco/tobacco-history/

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Tendências de uso: cigarro, vaping e alternativas

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Health and Food Safety, Special Eurobarometer: Attitudes of Europeans towards tobacco and electronic cigarettes. European Commission, 2021. https://europa.eu/eurobarometer/surveys/detail/2240 (22 julho 2024)

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Aspectos sociais e ambientais do uso de produtos sem fumaça

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Disponibilidade e acesso a produtos sem fumaça

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Global Tobacco Control, Country Laws Regulating E-Cigarettes. https://www.globaltobaccocontrol.org/en/policy-scan/e-cigarettes/sale

Cessação do tabagismo e alternativas terapêuticas

Padrões populacionais de cessação do tabagismo

Doll R., et al., Mortality in relation to smoking: 50 years’ observations on male British doctors. Br Med J, 2004. 328:1519. DOI: 10.1136/bmj.38142.554479.AE

U.S. Department of Health and Human Services, Smoking Cessation: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020. https://www.cdc.gov/tobacco-surgeon-general-reports/reports/2020-smoking-cessation/

Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. https://www.ncbi.nlm.nih.gov/books/NBK44695/

U.S. Department of Health and Human Services, The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S.

Tratamentos tradicionais para dependência de nicotina

Joseph, A.M., et al., Chronic disease management for tobacco dependence: a randomized, controlled trial. Arch Intern Med, 2011. 171(21): p. 1894-1900. DOI: 10.1001/archinternmed.2011.500

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Como a ciência avalia riscos, exposição e impactos

Como a ciência avalia riscos e exposição

Cordery, S., et al., The Product Science of Electrically Heated Tobacco Products: An Updated Narrative Review of the Scientific Literature. Cureus, 2024. 16(5): e61223. DOI: 10.7759/cureus.61223

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Margham, J., et al., Chemical composition of aerosol from an e-cigarette: a quantitative comparison with cigarette smoke. Chem Res Toxicol, 2016. 29(10): p. 1662-1678. DOI: 10.1021/acs.chemrestox.6b00188

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Bentley, M. C., et al., Comprehensive chemical characterization of the aerosol generated by a heated tobacco product by untargeted screening. Anal Bioanal Chem, 2020. 412: p. 2675-2685. DOI: 10.1007/s00216-020-02502-1

Azzopardi, D., et al., Chemical characterization of tobacco-free “modern” oral nicotine pouches and their position on the toxicant and risk continuums. Drug Chem Toxicol, 2022. 45(5): p. 2246-2254. DOI: 10.1080/01480545.2021.1925691

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Miller-Holt, J., et al., In vitro evaluation of mutagenic, cytotoxic, genotoxic and oral irritation potential of nicotine pouch products. Toxicol Rep, 2022. 9: p. 1316-1324. DOI: 10.1016/j.toxrep.2022.06.008

Lee, P.N., Epidemiological evidence relating snus to health–an updated review based on recent publications. Harm Reduct J, 2013. 10: 36. DOI: 10.1186/1477-7517-10-36

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Regulação, comunicação científica e experiências internacionais

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Consequências do mercado ilegal de produtos de nicotina

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Comunicação científica e publicações revisadas por pares

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Monitoramento de tendências regulatórias

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ECigIntelligence, Regulatory & Market Intelligence for the e-Cigarette Sector, ECigIntelligence market database, July Report, 2024

TobaccoIntelligence, Regulatory & Market Intelligence for Alternative Tobacco & Nicotine Products, Nicotine Pouch Market Database, Quarter 1 Report, 2024

Reino Unido: políticas públicas e redução do tabagismo

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Grécia: comunicação de risco voltada a fumantes adultos

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Japão: a experiência com produtos de tabaco aquecido

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Estados Unidos: evolução do mercado de produtos de vapor

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Nova Zelândia e Austrália: abordagens regulatórias contrastantes

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Suécia: trajetória rumo a níveis mínimos de tabagismo

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Paquistão: uso de nicotina oral em contextos de baixa e média renda

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Próximos passos para reduzir o impacto do tabagismo

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