Dual and polyuse of nicotine and tobacco products among adolescents in wartime Ukraine

Background

Adolescent nicotine use is rapidly transforming globally, with limited evidence from conflict settings. In Ukraine, the full-scale war has reshaped young people’s lives through displacement, stress, disrupted schooling and increased reliance on digital environments. This study examines how these factors intersect with the diversification of tobacco and nicotine products (TNPs), focusing on dual and polyuse.

Methods

We analysed data from the 2023 and 2027 Global Youth Tobacco Surveys (GYTS), a nationally representative survey of adolescents aged 13–15 years conducted under wartime conditions. The analysis assessed the use of multiple TNPs categories and patterns of dual and polyuse, alongside marketing and digital exposure and prevention gaps.

Results

In 2023, 25.7% of adolescents reported current use of any TNP. E-cigarettes were the most common product (19.6%), exceeding cigarettes (12.3%), indicating a shift to newer nicotine systems. Between 2017 and 2023 GYTS rounds, the use patterns are increasingly complex: single-product use declined (15.8% to 11.2%), while dual use rose (4.4% to 5.3%) and polyuse nearly doubled (2.4% to 4.9%). This reflects a shift from linear initiation to overlapping, multiproduct trajectories. Wartime conditions likely amplify these trends. Displacement, hybrid schooling and digital engagement may increase exposure to marketing and normalize use. Nearly half of adolescents reported noticing tobacco promotion, while school-based prevention declined to 44.4% (from 53.2% in 2017). Indicators of dependence, including daily e-cigarette use (4.4%) and morning cravings (11.8%), suggest early addiction among multiproduct users.

Conclusions

Adolescent nicotine use in Ukraine is increasingly defined by dual and polyuse shaped by market diversification and wartime conditions. Public health responses must shift to integrated, cross-product regulation and youth-focused interventions addressing both digital and offline risk environments.

Key messages

• Wartime conditions and digital exposure are reshaping adolescent nicotine use, accelerating dual and polyuse patterns.

• Tobacco control strategies must evolve from single-product approaches to comprehensive, multi-product and digitally responsive frameworks.