Popularity of heated-tobacco products and e-cigarettes among medical school students in Rome, Italy: factors associated with use and attitudes towards quitting

Background. Future health-care providers will counsel and deliver interventions on nicotine dependence based on their own perceptions and behaviors. The present study aims to assess changes in prevalence of use of nicotine-containing products and attitudes towards quitting use among medical students. Methods. A cross-sectional survey was performed during academic years 2019-2020 and 2021-2022 (total n=1949). Multivariable regression was conducted to examine factors associated with current product used. Results. Prevalence of current exclusive use of heated tobacco products significantly increased (from 3.1% to 6.6%), also in dual use with traditional cigarettes (from 0.6% to 1.9%). Exclusive use of traditional cigarettes declined (from 14.5% to 11.4%). Female students were more likely to currently use heated tobacco products. Knowledge in tobacco dependence and severity of dependence were also associated with use of newer tobacco products. Intentions to quit using in the near future remained low across academic years (~30%), independently from product used. Conclusions. The results indicate a rapid switch towards newer tobacco products and potential gender-related risk factors for the use of heated-tobacco products. Implementation of up-to-date medical school training on nicotine dependence and on new nicotine-containing products is warranted, to educate future health promoters and prevent tobacco-related harm.