BACKGROUND-AIM:
The nicotine landscape is undergoing a period of rapid development. In this study we examine the emerging situation among Irish teenagers regarding traditional and newer nicotine products - cigarettes, e-cigarettes, nicotine pouches, water pipe (shisha), moist snuff (snus), and heated tobacco products. We describe prevalence, availability/perceived access, age of first use, and early initiation (13 years or younger).

METHODS:
We use data from a nationally representative stratified random sample of (n=5587) 15-18 year olds in Ireland, collected online in 2024 (ESPAD protocol). Respondents were asked if they had ever used any of the listed products and, if yes, whether they had done so in the previous 30 days (current use). Perceived availability was measured by the question: How difficult do you think it would be for you to access (the following products) if you wanted? Cigarettes, e-cigarettes (vapes, mods) and alternative smoking products (nicotine pouches, water pipe (shisha), snus, heated tobacco products). There were 6 answer categories: Impossible, Very difficult, Fairly difficult, Fairly easy, Very easy, Don’t know. Age of initiation assessed the age respondents first reported using 4 products ranging from 9 to 16 years of age or older.

RESULTS:
Prevalence of ever and current smoking (31.2%, 14.2%), e-cigarettes (39.3%, 20.6%), water pipes/shisha (5.1%, 1.2%), moist snuff/snus (13.6%, 6.2%), heated tobacco products (8.0%, 3.1%), nicotine pouches (9.4%, 5.1%). E-cigarettes were reported as the most available nicotine product with 71.8% (n=3777) reporting them to be “fairly easy” or “very easy” to access, compared with 66.4% (n=3508) for cigarettes, 43.4% (n=2252) for moist snuff, 37.2% (n=1039) for nicotine pouches, 27.7% (n=1431) for heated tobacco products, and 14.8% (n= 763) Water Pipes/Shisha. Early initiation (aged 13 years or younger) was highest for e-cigarettes at 13.7% (n=718), higher than for cigarettes at 10.4% (n=554). By comparison, 1.3% (n=43) and 1% (n=33) reported early initiation for nicotine pouches and moist snuff (snus) respectively. Age 14 and 15 years were the most common ages for starting e-cigarette use and smoking respectively, while 16 years was the most common age for starting to use the newer nicotine products.

CONCLUSIONS:
E-cigarettes are the nicotine product most used by 15-18 year olds with 4 in 10 having tried them and more than one in five being current users. They are also the easiest to access of all products and the product most tried by early users (age 13 or younger) reflecting lack of regulation until 2024. Teenager smoking seems not to have been reduced by e-cigarette use, with almost a third having tried smoking and 14% being current smokers. Moist snuff (snus)/nicotine pouches have been tried by more than one in ten teenagers and about four in every ten perceive them to be easy to access. Emerging nicotine products pose a new and additional risk for addiction. More stringent regulation of use by teenagers is needed.