Abstract
Smoking is a leading risk factor for many preventable chronic diseases across the lifespan. Adolescence represents a critical period for the adoption of health-risk behaviours, including tobacco and nicotine products consumption. Evidence shows that adolescents who are susceptible to tobacco use are more likely to initiate and maintain smoking than their non-susceptible peers. This study examines factors associated with susceptibility to cigarettes, electronic cigarettes (e-cigs) and heated tobacco products (HTPs) in adolescents aged 13-15 years. Data were drawn from the 2022 Global Youth Tobacco Survey conducted in eight Italian regions. Susceptibility to tobacco products was measured through intentions to use tobacco and responses to hypothetical peer offers. Influencing factors (i.e. age, gender, having smoking friends or parents, exposure to tobacco advertising and to anti-smoking messages at school) were evaluated using a multivariable random intercept logistic regression to account for variability between macro-regions (North, Centre, South). The study included 17 713 participants from 738 schools and 1219 classes. Susceptibility to cigarettes was 27.8%, to e-cigs 36.6%, and to HTPs 29.5%. Regional differences emerged, with higher cigarette susceptibility in the South and higher e-cig susceptibility in the North. Having smoking friends was the strongest risk factor [cigarettes: odds ratio (OR) = 2.02, e-cigs: OR = 2.03, HTPs: OR = 2.22]. Anti-smoking messages at school were protective (cigarettes: OR = 0.92, e-cigarettes: OR = 0.91, HTPs: OR = 0.88). Individual factors had a stronger influence than geographical differences. The findings underscore the need for comprehensive tobacco control policies addressing the rising prevalence of poly-product use, stronger marketing regulations, and school-based and peer-led interventions.