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.