Background:
In Italy, tobacco smoking among adolescents is highly prevalent and has been increasing in recent years. Introduction of alternative products has led to a shift in smoking habits among younger, which needs to be monitored.

Objectives:
To assess the temporal trends in the use and accessibility of cigarettes, electronic cigarettes (e-cig), and heated tobacco products (HTPs) among 13-15-year-old students enrolled in Italian schools.

Methods:
Data from four editions of GYTS were used: from 2010 to 2022, for a total of 6,602 adolescents.

Results:
Prevalence of current cigarette users among 13-15-year-olds decreased from 21% in 2010 (19% for boys and 22% for girls) to 15% in 2022 (13% vs 17%). Ever cigarette smokers followed a similar trend. For e-cig, considered from 2014, the prevalence of current users was 8% in 2014 (11% for boys and 6% for girls), and it increased to 20% in 2022, 21% for girls and 18% for boys. HTPs were ever used by 23% of adolescents in 2022 (20% for boys and 27% for girls) and currently used by 14% (12% vs. 16%). In 2022, 24% of smokers obtained cigarettes directly from tobacco shops (compared to 49% in 2010), and among current smokers who attempted to purchase cigarettes from a store, 73% reported no refusal from the seller due to their underage status (compared to 92% in 2010). 15% of adolescents (9% of boys and 20% of girls) purchased e-cig directly from retailers, and only one in four experienced a sales refusal due to their age.

Conclusions:
Italy has seen an increase in e-cig use, especially among girls, and a decrease in traditional cigarette use. HTPs are widespread and will require continued monitoring in the coming years. Monitoring tobacco and nicotine consumption among adolescents is strategic to support policies against tobacco and nicotine use.