Nicotine-Product Use, Perceptions and Associated Factors Among Final-Year Secondary-School Students in Novi Sad, Serbia: A Cross-Sectional Study

Background/Objectives: Adolescent nicotine use increasingly extends beyond cigarettes to e-cigarettes, heated tobacco products and oral nicotine. This study aimed to characterize nicotine-product use, knowledge, risk perceptions and associated factors among final-year secondary-school students in Novi Sad, Serbia. Methods: A cross-sectional online survey was conducted among 205 students aged ≥18 years from general, medical and vocational schools in April–June 2026. Current use of cigarettes, e-cigarettes, IQOS, snus and waterpipe was self-reported without a fixed recall period, alongside knowledge, perceived harmfulness and social context. Exploratory multivariable logistic regression identified correlates of current use. Results: Overall, 49.3% of respondents (95% CI 42.5–56.1) reported current use of at least one product. IQOS was the most frequently used product (32.7%), followed by e-cigarettes (25.9%) and cigarettes (24.9%). Close-friend use was associated with higher odds of current use (adjusted odds ratio [aOR] 8.09 per category; 95% CI 3.36–19.51), whereas higher physical activity (aOR 0.43; 95% CI 0.26–0.72) and perceived harmfulness (aOR 0.42; 95% CI 0.19–0.94) were associated with lower odds. Knowledge scores did not differ by current use. Conclusions: Nicotine-product use, particularly of heated tobacco products and e-cigarettes, was common in this convenience sample. Current use was associated with close-friend use and lower perceived harmfulness, most clearly for cigarettes and IQOS, but not with factual knowledge. Prevention efforts may need to go beyond knowledge transfer and consider the peer context and perceptions of specific products.