Background:
This study represents a 2023 update of our continuous tracking of tobacco product use in Serbia.

Objectives:
We aimed to explore the frequency of use of traditional (manufactured and roll-your-own) and novel (heated and vaping) products in tobacco users as well as the transitions in use of these products. Also, we explored whether the products used were purchased (il)legally.

Methods:
To address the aims, we conducted the field survey on 1000 adult participants aged between 18 and 87. The sampling procedure was probabilistic and included the individuals who use any of the products: manufactured and roll-your-own cigarettes, heated tobacco products, and vaping products. The participants were also asked whether they had used each of the products in the past and about the place of the purchase of the products they currently use.

Results:
The results showed that the use of manufactured (83.3%) and roll-your-own (13.6%) cigarettes is the most frequent, while the use of heated tobacco products (3.0%) and vaping products with (2.1%) and without nicotine (1.0%) is less frequent. The total overlap of the product consumption among the users was 3.0% (i.e., 30 out of 1000 used more than one product). Considering the transition between the products, we observed that former users of manufactured cigarettes comprise the majority of current users of roll-your-own cigarettes (62.5%), heated tobacco products (76.7%), and vaping products with nicotine (76.2%). The manufactured cigarettes (over 99%), heated tobacco (100%), and vaping products (100%) were almost entirely purchased legally, while more than 60% of roll-your-own tobacco was purchased illegally.

Conclusions:
Although manufactured cigarettes are still the most frequently used tobacco product, there is an evident transition to roll-your-own tobacco and heated and vaping products, which aligns with our previous findings.