Prevalence, risk perception, and motivations behind E-cigarettes and heated tobacco use: a cross-sectional study in Italian adolescents.

BACKGROUND: E-cigarettes and Heated Tobacco Products (HTPs), which emerged as "safer" alternatives to traditional cigarettes, remain easily accessible and widely misperceived as harmless, especially among adolescents. Our study aimed to assess the prevalence of e-cigarette and HTP use among Italian adolescents, and investigate underlying motivations, risk perceptions, and social influences. METHODS: We conducted a cross-sectional survey among 200 adolescents aged 11-18 years. Participants completed a 50-item anonymous questionnaire exploring sociodemographic characteristics, smoking behaviors, reasons for use, risk awareness, and social influence. RESULTS: Among participants, 23% reported using e-cigarettes and 16% HTPs. Disposable, flavored and nicotine-containing products were highly prevalent. Among vapers, use was significantly more frequent in those aged > 14 years, and in individuals reporting social influence, stress, or sadness/apathy. Similar patterns were observed among HTP users. Risk perception was low: 85% of participants believed e-smoking was less harmful than conventional smoking, and only 5% recognized e-cigarettes as significantly harmful. Only 20% of all participants had been asked about smoking during medical visits, with significantly lower rates among those < 14 years. A comprehensive analysis of usage patterns, psychosocial correlates, and risk perception is provided in the full manuscript. CONCLUSION: The underestimation of health risks associated with electronic smoking devices pose a serious Public Health challenge. Findings highlight the urgent need for targeted interventions combining stricter access control, enhanced risk communication, and integration of tobacco prevention into school and clinical settings. Greater attention should be paid to the psychological dimension of adolescent smoking and the evolving landscape of nicotine delivery systems.