Background:
In the past decade, the presence of various nicotine-containing products increased in many countries leading to the change in prevalence and patterns of nicotine use among youth. The aim of this analysis was to explore changes in prevalence of tobacco use among Serbian adolescents between 2018-2022.

Methods:
The data used for this analysis were obtained through Health Behavior in School-aged Children Survey (HBSC) implemented in Serbia by the Institute of Public Health of Serbia among school children. The surveys were conducted at the nationally representative samples of students 11,13 and 15 years old (4028 students in 2018 and 3962 in 2022). Trend and/or prevalence of cigarette, e-cigarette, waterpipe and snus was analyzed to determine potential changes and determine emerging issues for interventions.

Results:
Data show no statistically significant change in prevalence of cigarette smoking between 2018 and 2022 (9.5% and 10.2% respectively) among 11,13- and 15-years old students and significant decrease in waterpipe smoking (16.6% in 2018 and 7,1% in 2022) among students 15 years old. In 2022, questions on e-cigarette, heated tobacco products and snus use were included in the survey and results show high popularity of these products. Among 15- year old students, 19.9% were current e-cigarette users, 4.9 % currently used snus and 6.4% heated tobacco products. The prevalence of experimentation with these products was higher, especially for e-cigarettes, that were used by 30.1% of 15-year-old students at least once in the lifetime.

Conclusions:
Results show high popularity of emerging nicotine and tobacco products among youth in Serbia and steady prevalence of cigarette use. High prevalence of e-cigarette use, snus and heated tobacco products stress the importance of urgent measures that would limit exposure to the marketing, promotion and availability of these products to the youth.