Changing patterns of nicotine product use in the urban population: sociodemographic differences and increasing use of e-cigarettes and heated tobacco products.

INTRODUCTION

Cigarette smoking remains a leading cause of preventable death, while e-cigarettes and heated tobacco products (HTPs) are gaining popularity. Population-based data are essential for tobacco control policy.

OBJECTIVES

This study aimed to assess the prevalence and sociodemographic differences in conventional cigarette, e-cigarette, and HTP use in an urban Polish population.

PATIENTS AND

METHODS

A total of 3527 participants aged 20-79 years from the population-based Bialystok PLUS study were examined between 2018 and 2025; 3407 participants (96.6%) with complete data were analyzed. Data were collected using standardized questionnaires. Groups were compared with analysis of variance and χ² tests (Bonferroni-adjusted); temporal trends were assessed with modified Poisson regression.

RESULTS

Mean age was 49.2 years and 55.8% were women; 22.7% used any nicotine product. Exclusive use was 14.3% for cigarettes, 2.8% for e-cigarettes, and 1.3% for HTPs; 4.3% used 2 or 3 products. Including dual and triple use, 18.4% used cigarettes, 5.3% e-cigarettes, and 4.1% HTPs. Overall use was stable (prevalence ratio [PR] per study year, 1.02; 95% CI, 0.98-1.06), but exclusive cigarette smoking fell (PR, 0.91; 95% CI, 0.87-0.96) and exclusive e-cigarette use rose (PR, 1.33; 95% CI, 1.13-1.57). Nicotine use was associated with male sex, younger age, lower education, and unmarried status; non-combustible product users were younger, better educated, and more often in paid employment.

CONCLUSIONS

In this urban population, overall nicotine use remained stable while cigarette smoking declined, and use of newer products and poly-use increased. Prevention strategies should address evolving poly-use, particularly among younger adults; these single-city findings may not apply nationwide.