Background:
Tobacco and nicotine use among European teenagers still remains a major public health concern. In the whole WHO European Region, including five selected countries, the prevalence of tobacco use by teenagers substantially varies.

Objectives:
1/ To overview the picture of tobacco, e-cigarette and heated tobacco use in Europe among 13-15 years-old schoolchildren; 2/ to evaluate and compare the prevalence and trends in the use of above products in selected European countries; 2/ to identify major tobacco control challenges in youth population in analyzed countries.

Material and Methods:
The presented research findings are based on results of the Global Youth Tobacco Survey. GYTS is a cross-sectional, nationally representative school-based self-administered questionnaire survey of school students aged 13 to 15 years. GYTS includes a two-stage (school and classes) sample design with schools selected with a probability proportional to enrollment size.

Results:
GYTS data from four analyzed countries show a substantial decrease in cigarette smoking and the use of other traditional tobacco products and, at the same time, a sharp increase in the use of novel and emerging tobacco and nicotine products, in particular e-cigarettes, among 13-15 years-old adolescents. Only in San Marino the prevalence of any tobacco products use tends to increase, comparably to increase in e-cigarette and heated tobacco use. In all analyzed countries, current use of e-cigarettes is at higher level than the use of traditional tobacco products. Additional challenges are associated with the increase of dual use of cigarettes and e-cigarettes or heated tobacco among adolescents and a rapid uptake of novel and emerging tobacco and nicotine products by young girls. In some countries, the prevalence of e-cigarette use among girls now exceeds that of boys.

Conclusions:
The GYTS data from the WHO European Region show a sharp increase in the use of e-cigarettes, heated tobacco and dual product use among young people, and underscores the urgent need to implement bold, robust, comprehensive and multi-sectoral tobacco control strategy. This strategy should include population and school-based preventive programs, the creation of tobacco-free environments, the provision of youth tobacco cessation services, and the implementation of legislative measures. These measures should be aligned with the guidance provided by the WHO Framework Convention on Tobacco Control and be strictly enforced.