{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T02:28:14Z","timestamp":1793500094099,"version":"4.5.0"},"reference-count":26,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2026,1,21]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While cigarettes remain the most common form of tobacco product used, the global tobacco landscape is changing with the introduction and marketing of newer products.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We examined the latest two waves of Global Youth Tobacco Survey data from 13 countries that implemented the survey between 2013 and 2023 to assess changes in exclusive, dual and poly-tobacco product use over time among students aged 13\u201315 years. Current tobacco use, defined as using any form of tobacco in the past 30 days, was categorised into six mutually exclusive variables: exclusive smoked tobacco, exclusive smokeless tobacco, exclusive heated tobacco, exclusive electronic cigarettes (e-cigarettes), dual use and poly-tobacco use. Multivariable logistic regression models adjusted for survey year, sex and age were used to estimate adjusted prevalence differences (aPDs) between survey rounds, accounting for the complex sampling design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Exclusive smoked tobacco declined significantly in six countries, with aPDs ranging from \u22128.8\u2009percentage points (95%\u2009CI \u221211.1 to \u22126.6) in Latvia to \u22122.8 points (95%\u2009CI \u22124.1 to \u22121.4) in Paraguay.<\/jats:p>\n                    <jats:p>Exclusive e-cigarette use increased in nine countries, ranging from 1.2 points (95% CI 0.3 to 2.1) in Albania to 6.6 points (95% CI 4.4 to 8.8) in the Czech Republic.<\/jats:p>\n                    <jats:p>Dual and\/or poly-tobacco use also increased in eight countries, from 0.5 points (95% CI 0.0 to 0.9) in Nicaragua to 6.6 points (95% CI 3.0 to 10.2) in San Marino.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There has been a shift in tobacco use patterns, moving from smoked tobacco to e-cigarettes and poly-tobacco use. Comprehensive implementation of tobacco control strategies may contribute to addressing emerging trends in tobacco use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2025-059875","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:50:24Z","timestamp":1771606224000},"page":"tc-2025-059875","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Changes in tobacco use patterns among students aged 13\u201315 years in 13 countries: Global Youth Tobacco Survey, 2013\u20132023"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7116-5003","authenticated-orcid":false,"given":"Nerline","family":"Jacques","sequence":"first","affiliation":[{"name":"Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"CyberData Technologies, Herndon, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-8719","authenticated-orcid":false,"given":"Liping","family":"Pan","sequence":"additional","affiliation":[{"name":"Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8923-613X","authenticated-orcid":false,"given":"Rene A","family":"Arrazola","sequence":"additional","affiliation":[{"name":"Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candace","family":"Kirksey Jones","sequence":"additional","affiliation":[{"name":"Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adewole","family":"Adetokun","sequence":"additional","affiliation":[{"name":"Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"CyberData Technologies, Herndon, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indu B","family":"Ahluwalia","sequence":"additional","affiliation":[{"name":"Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026022008501474000_tc-2025-059875v1.1","doi-asserted-by":"crossref","first-page":"e472","DOI":"10.1016\/S2468-2667(21)00102-X","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990-2019","volume":"6","author":"Reitsma","year":"2021","journal-title":"Lancet Public Health"},{"key":"2026022008501474000_tc-2025-059875v1.2","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S2352-4642(20)30390-4","article-title":"Prevalence and trends in tobacco use among adolescents aged 13\u201315 years in 143 countries, 1999\u20132018: findings from the Global Youth Tobacco Surveys","volume":"5","author":"Ma","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"2026022008501474000_tc-2025-059875v1.3","unstructured":"World Health Organization . 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