Prevalence and patterns of electronic cigarette and heated tobacco product use among Italian adults in 2024: A cross-sectional study

INTRODUCTION Electronic cigarettes (ECs) and heated tobacco products (HTPs) have gained popularity worldwide, despite concerns about their safety. In Italy, updated national data on these devices remain scarce. The aim of this study is to estimate prevalence, patterns, determinants and trends of EC and HTP use among Italian adults in 2024. METHODS A face-to-face cross-sectional survey was conducted in 2024 on a representative sample of 3125 Italian individuals aged ≥15 years. Data were collected through interviewer-administered questionnaires and included selfreported information on conventional cigarette (CC), EC, and HTP use. We used multivariable logistic regression models to assess adjusted odds ratios (AOR) for EC and HTP use, including sex, age, education level, and smoking status as covariates. Trends (2022–2024) were assessed using analogous surveys. RESULTS In 2024, 2.3% (95% CI: 1.7–2.8) of Italian adults used EC, and 4.5% (95% CI: 3.7–5.2) HTP. Use of both products declined with age (p for trend <0.001). Dual use with CCs was prevalent among EC (87.8%; 95% CI: 80.1–95.4) and HTP (92.5%; 95% CI: 88.1–96.8) users. Compared with current CC smokers, odds of EC and HTP use were lower in never (EC: AOR=0.04; 95% CI: 0.02–0.09; HTP: AOR=0.01, 95% CI: 0.00–0.03) and former smokers (EC: AOR=0.14; 95% CI: 0.04–0.48; HTP: AOR=0.18; 95% CI: 0.08–0.41). Use of HTP increased by 40% over two years (p for trend = 0.085). Use of EC did not substantially change. CONCLUSIONS The widespread dual use and the increasing prevalence of HTP use in Italy highlight growing public health concerns. Instead of serving as cessation aids for smokers, these devices are frequently used by youth and alongside CCs.