ArticleTobacco prevention & cessation2026
Prevalence and factors associated with of use of heated tobacco products and nicotine pouches in the European Union in 2023.
Article in Tobacco prevention & cessation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Heated tobacco products (HTPs) and nicotine pouches (NPs) are emerging nicotine containing products. This study aims to examine the prevalence and patterns of use of HTPs and NPs, and factors associated with starting to use HTPs among European Union (EU) Member State (MS) citizens. Methods: We conducted a secondary analysis of data from the Special Eurobarometer 539 survey on attitudes towards tobacco and related products, carried out between May and June 2023, which included 26359 individuals aged ≥ 15 years across the 27 EU MS. We performed two-level logistic regression models, including sociodemographic factors as independent variables, to identify factors associated with HTP and NP current and ever use and reasons to start using HTPs. Results: In 2023, 1.7% (95% CI: 1.4-1.9) of EU MS citizens were current users of HTPs and 1.0% (95% CI: 0.9-1.3) were current users of NPs; 81.2% (95% CI: 75.6-85.8) of all current HTP users were concurrently smoking tobacco, while 43.5% (95% CI: 34.4-53.1) of current NP users were also current smokers, whereas 4.3% (95% CI: 2.16-83.6) of HTP users and 18.3% (95% CI: 12.1-26.8) of NP users had never smoked tobacco. Individuals aged 15-24 years were more likely to be current users of HTPs (AOR=4.21; 95% CI: 2.67-6.64), ever users of HTPs (AOR=9.70; 95% CI: 7.66-12.29), current users of NPs (AOR=7.36; 95% CI: 4.11-13.18) and ever users of NPs (AOR=6.48; 95% CI: 4.95-8.47). Finally, individuals aged 15-24 years (AOR=5.31; 95% CI: 1.72-16.38) and 25-39 years (AOR=2.68; 95% CI: 1.19-6.42) were more likely to have reported to have commenced HTP use because they liked HTP flavors. Conclusions: Although the overall prevalence of HTP and NP use in 2023 within the EU remained low, usage was concentrated among younger individuals, with dual use with conventional tobacco products being common. The emergence of NP use among individuals who have never smoked, along with the role of HTP flavors on HTP initiation among young people, are particularly concerning.
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