Smoking E-CigaRette and HEat-noT-burn Products: the SECRHET study, a large observational survey among young people in Italy

Aim: Electronic cigarettes (eCig) and heated tobacco products (HTP), that heat a solution (e-liquid) to create vapour and tobacco at a temperature below the point of combustion, respectively, are emerging forms of smoking device widely diffused. The aim of this study was to investigate knowledge, attitudes and behaviour toward HTP among young people in Italy. Methods: The Smoking E-CigaRette and HEat-noT-burn products (SECRHET) study was an online survey carried out in April 2019 using the platform Skuola.net, a platform where 2.5 million students are registered. Questions were related to knowledge about new generation smoking products, such as “Do you know what happens to tobacco when you use a heat-not-burn product?”, “Do you think electronic cigarettes create addiction?”, “Are products that use heated tobacco harmful to health?”, “Are electronic cigarettes harmful to health?”, “Have you ever heard of products that use heated tobacco?”, “Is nicotine present in products that use heated tobacco?”  Results: A total of 13882 people completed the questionnaire, of which 8056 (58%) were females. Regarding smoking habits, 3393 (24.4%) declared to be current cigarette smokers, while 802 (5.8%) and 3173 (22.9%) were current and former e-cigarette smokers, respectively. Moreover, 715 (5.2%) and 1148 (8.3%) declared to be current and former heat-not-burn cigarette smokers. The variables associated to both eCig and HTP use were current smoking, age over 18 years, male gender, and residence in Central and Southern Regions. Concerning knowledge issues, almost half of respondents believe that electronic cigarettes are addictive and are harmful to health. Moreover, most of respondents do not know what happens to tobacco when using a heated tobacco device and if heated tobacco products are harmful to health. Conclusion: The prevalence of eCig and HTP use is higher among young people in Italy compared to adults and older people, and requires adequate public health interventions.     Conflicts of interest: None declared.   Funding: This research received no external funding.   Acknowledgments: The authors are grateful to the personnel of skuola.net