Heated tobacco product use among Tunisian adolescents: prevalence, patterns, adverse effects, and determinants of use

Objectives Tobacco use among adolescents remains a public health issue. The rise of novel and emerging tobacco products such as Heated Tobacco Products (HTPs) has gained popularity and is often marketed as a less harmful alternative to conventional cigarettes. Our study aimed to determine the prevalence of HTP use among Tunisian adolescents, describe patterns and adverse effects associated with these products, and assess the main determinants of HTP use. Methods A cross-sectional survey was conducted in September-October 2024 among a representative sample of adolescents enrolled in middle and high school institutions in Sfax, Tunisia. Data were recorded using an anonymous self-administered questionnaire. Results A total of 980 adolescents were enrolled. The prevalence of current HTPs use was 2 % (n=20). Concerning patterns of HTPs use, 44 % (n=11) of ever HTP users obtained their first HTP device from friends, and 64.7 % (n=11) obtained refills from specialty stores. Regarding the reasons for experimentation, curiosity (66.7 %, n=16) and peer influence (28.6 %, n=6) were the most cited reasons. As for the reported adverse effects, drowsiness (38.1 %, n=8) was the most frequently reported among ever HTP users. Multivariate analysis revealed that factors independently associated with current HTP use among adolescents were current shisha use (AOR=19.91; p=0.005), having a brother who uses HTP (AOR=19.64; p=0.016), and current use of conventional cigarettes (AOR=9.02; p=0.021). Conclusions Our study showed a relatively low but non – negligible prevalence of HTPs use among adolescents. These findings highlight the need for targeted prevention strategies and stricter enforcement of regulations prohibiting the sale of these products to adolescents.