Background:
Up-to-date research regarding the prevalence of consumption of tobacco products is needed for appropriate health promotion.

Objective:
This study assesses smoking, use of electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) among medical students, giving special attention to the influences of the COVID-19 pandemic on them.

Methods:
A cross-sectional study was performed using an on-line anonymous questionnaire during the university year 2020/2021 among 743 medical students from the University of Medicine and Pharmacy from Cluj-Napoca, Romania (457 Romanian students and 286 international students).

Results:
Half of the students have smoked at least once during their lifetime, around one-third have used e-cigarettes and one quarter has tried HTP at least once during their lifetime. Regarding consumption in the last month, smoking was present among one-third of the students; e-cigarette was used by less than 4% of students, while consumption of HTP was declared by 6% of Romanian students and 13% of international students. During the first waves of the COVID-19 pandemic, 35% of Romanian students and 40% of international students consumed at least one of the three products. With regard to the declared influence of the COVID-19 pandemic on behavior, among Romanian students both for smoking and e-cigarette use the percentage of those who declared a decrease in consumption (decreased the frequency/quantity, tried to quit or even succeeded to quit) was higher than the percentage of those who increased consumption (started to use or increase frequency/ quantity), while for HTP was the inverse. Among international students, the percentages of those who decreased smoking or increased smoking during the pandemic were similar; for e-cigarette a tendency to decrease was noticed for more students, while HTP consumption increased for a higher percentage of students.

Conclusions:
The COVID-19 pandemic had consequences on smoking and the use of novel tobacco products, which should lead to appropriate measures of tobacco control.