BACKGROUND: Numerous studies indicate sex and age differences in tobacco use, but less is known about these differences regarding the use of nicotine products, which have been increasing among adolescents over the past decade.
METHODS: Secondary analyses of the 2022 Health Behaviour in School-Aged Children (HBSC) survey data in Serbia were conducted. The sample (N= 3962) included students 11, 13, and 15 years old. Five multivariate logistic regression models examined sex and grade differences in the lifetime use of cigarettes, e-cigarettes, water pipes, oral nicotine pouches, and heated tobacco products.
RESULTS: Lifetime prevalence of cigarette (15.1%), e-cigarette (19.7%), waterpipe (7.1%), oral nicotine pouches (4.9%) and heated tobacco products (6.3%) in total sample shows the difference in popularity of explored products. Five multivariate logistic regression models examined showed no significant differences by sex after adjusting for grade, but grade was a significant factor. Compared to 11 years old students, 13 years old were 2.81 times as likely to have smoked cigarettes (p<0.001) and 3.08 times as likely to have used e-cigarettes (p<0.001), adjusting for sex. Students 15 years old were 6.38 times as likely to have used cigarettes (p<0.001) and 5.82 times as likely to have used e-cigarettes (p<0.001) compared to 11 and 13 years old, adjusting for sex. Oral nicotine pouch use was significantly higher among boys than girls (p<0.001) and 2.79 times higher among 15 compared to 11 years old students (p<0.001).
CONCLUSIONS: Sharp increase in lifetime prevalence of all explored tobacco and nicotine products from 11 to 15 years confirming this period as crucial for interventions. Results show higher susceptibility to oral nicotine pouches use of boys compared with girls stressing importance of targeted interventions for them.