Heated Tobacco Product Awareness and Use Among Young Adult Texas College Students During a Period of Renewed Market Activity, 2025-2026.

Little is known about heated tobacco product (HTP; e.g., IQOS) use among young adults following IQOS reentry to the US market, initially centered in Austin, Texas. We examined HTP awareness and use among Texas college students during renewed market activity. Repeated cross-sectional surveys included 17,750 participants (18-29y) attending 19 Texas colleges in 2025 and 2026. Mixed-effects logistic regression models examined changes in HTP awareness and use by survey year, campus location (Austin vs. non-Austin), and demographic, tobacco use, and cessation correlates. Overall, 14.8% reported HTP awareness, 2.5% lifetime use, and 0.6% past-30-day use. HTP outcomes did not change from 2025 to 2026 or differ by campus location. Males (vs. females) had higher odds of HTP awareness (OR = 1.48, 95%CI:1.36-1.61) and lifetime use (OR = 1.40, 95%CI:1.15-1.70). Asian (vs. non-Hispanic White) participants had lower odds of awareness (OR = 0.76, 95%CI:0.66-0.86) and lifetime use (OR = 0.54, 95%CI:0.37-0.79). Former and current (vs. never) smoking, smokeless tobacco, and nicotine pouch use were positively associated with awareness and use (OR range = 1.25-4.25). E-cigarette use was associated with lower odds of awareness (OR = 0.79, 95%CI:0.69-0.90) but higher odds of lifetime (OR = 2.13, 95%CI:1.69-2.69) and past 30-day use (OR = 10.40, 95%CI:6.09-17.60). Currently trying to quit tobacco was associated with greater odds of lifetime use (OR = 1.45, 95%CI:1.05-2.00); no other cessation associations were observed. HTP use was uncommon but more frequently reported among young adults using other tobacco products. Findings did not indicate a consistent pattern of HTP use in the context of tobacco cessation. Continued surveillance is warranted as HTP availability expands.