Background:
In addition to existing alternative forms of tobacco and nicotine delivery (e.g., water/shisha pipes, snus), newer forms of tobacco and nicotine delivery (e.g., e-cigarettes, heated tobacco products, and oral nicotine products) emerged as a response to declines in cigarette smoking prevalence and the consolidation of the tobacco industry, with concern about uptake among younger populations, despite little available data.

Objectives:
To examine trends between 2019 and 2024 in the use of water pipes, moist snuff (snus), heated tobacco products, and nicotine pouches in 16-year-olds in Ireland. To examine gender differences in the use of these products.

Methods:
ESPAD is the European School Survey Project on Alcohol and other Drugs. We use data from 2 Waves of ESPAD Ireland (2019, n=1,947; 2024, n=2,002). In 2019, respondents were asked if they had ever used water pipe, moist snuff (snus), 'heat-not-burn' tobacco and, in 2024, water pipe (shisha), moist snuff (snus), heated tobacco products, and nicotine pouches, re-coded yes/no for lifetime use.

Results:
Between 2019 and 2024, there was a decrease in lifetime use of water pipes (6%-3.8%) and an increase in heated tobacco products (3.2%-7.2%) and moist snuff (2.8%-10.7%). No data were collected on nicotine pouches in 2019; in 2024, prevalence was 8.1%. Male teenagers reported significantly higher prevalence for all products in both years, except for heated tobacco products in 2024, when female teenagers had slightly higher use. Moist snuff showed the greatest increase between 2019 and 2024, 3.5%-14.3% for males and 2.1%-6.3% for females. We note the consistently very high prevalence for all products reported by those who answered “Rather Not Say” to the question “What is your sex?” in 2024.

Conclusion:
The use of alternative tobacco and nicotine products by teenagers in Ireland is high and increasing. As smoking prevalence declines, education and cessation interventions for these products are needed.