Sociodemographic patterns of cigarette, e-cigarette and heated tobacco use in the Polish population: Bialystok PLUS population study

Background Smoking remains one of the most significant public health concerns and it remains the leading cause of preventable disease and death. More than 8 million people die each year worldwide from tobacco-related diseases [1]. It is estimated that tobacco products (mainly cigarettes) were used by 22% of the global adult population in 2020, and more than 80% of all users live in low- and middle-income countries [1]. In addition to conventional cigarettes, alternative tobacco products such as electronic cigarettes (e-cigarettes) and heated tobacco products have been gaining popularity [2]. Purpose The aim of the study was to assess the prevalence of different nicotine-delivery methods in the Polish population and sociodemographic characteristics of groups using selected methods of nicotine intake. Methods The data were obtained from the Bialystok PLUS study conducted on a representative sample of Bialystok residents aged 20-79 years. A total of 3527 respondents were examined between 5th November 2018 and 24th March 2025. All participants underwent a detailed interview, collection of demographic data, and assessment of lifestyle factors, including the use of various nicotine products. There were 102 individuals with missing smoking data. Information on smoking status and educational level was available for 3420 participants, whereas information on smoking status and household income was available for 2442 participants. Results Usage of at least one of three methods of smoking was declared by 775 participants, accounting for 22.6% of the population. Smoking regular cigarettes was declared by 628, e-cigarettes by 181, heated tobacco products by 140 individuals, which accounted for 17.8%, 5.1% and 3.9% respectively. Traditional cigarette users were predominantly individuals with primary and secondary education 63%, whereas users of heated tobacco products were more likely to have higher education 56%. In terms of income, a higher percentage of e-cigarette and heated tobacco users reported a monthly income exceeding 7000 PLN. When stratified by age, traditional cigarette users were predominantly 40-64 years old 51%, whereas e-cigarette and heated tobacco users were mainly younger adults: 71% and 57% aged 20-39 years. The mean age of traditional cigarette smokers was 48 ±14.6, compared with 34 ± 12.2 among e-cigarette users and 38 ± 11.2 among heated tobacco users. Conclusion In this population-based cohort, traditional cigarettes remained the predominant form of nicotine use, while e-cigarettes and heated tobacco products were more common among younger, higher-educated participants with higher income. Consequently, tobacco-control strategies should target not only traditional, but also emerging nicotine products, and be customised according the sociodemographic profiles of users, given the still limited evidence on their long-term health effects.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.