Smoking inequalities and regular use of newer nicotine products in Cyprus: a population-based study

Background

Tobacco smoking remains a leading preventable cause of death and disease. As tobacco and nicotine markets diversify beyond cigarettes, we examined socioeconomic inequalities in combustible smoking and patterns of newer nicotine and tobacco product use in Cyprus.

Methods

We analysed cross-sectional survey data from the Cyprus Observatory for Tobacco and Nicotine Use among 1,008 adults in Cyprus. Weighted prevalence estimates used sex, age and district weights. Multivariable logistic regression examined combustible smoking, e-cigarette and heated tobacco product (HTP) use, adjusting for sex, age, district, education and household income. Reference categories were household income ≤€1000/month and primary/secondary education.

Results

Current regular combustible smoking was 27.9%, versus 19.4% for HTPs and 5.0% for e-cigarettes. Smoking showed socioeconomic inequalities: university education (OR = 0.54, 95%CI:0.36–0.80) and incomes €1001–1500 (OR = 0.34, 0.19–0.62) and €1501–2200 (OR = 0.46, 0.26–0.81), versus ≤€1000, were associated with lower odds of current combustible smoking. Adults aged 35–44 had higher odds of smoking than those aged 18–24 (OR = 2.48, 1.24–4.96). Regular e-cigarette use reached 12.8% among 18–24-year-olds. Regular HTP use was especially high in younger adults, reaching 47.6% in those aged 18–24 and 35.1% in those aged 25–34; all older age groups had markedly lower odds of current HTP use than 18–24-year-olds. Dual/poly-use was common (18.1% overall; 53.6% among 18–24-year-olds). Among current combustible smokers, 24.6% intended to quit within 6 months and 70.2% of quit attempts were made without help.

Conclusions

Cyprus faces a dual challenge: persistent socioeconomic inequalities in combustible smoking and high regular HTP use among younger adults. Tobacco control should move beyond cigarettes alone, strengthen surveillance across nicotine products, and improve youth-focused prevention and access to evidence-based cessation support.

Key messages

• Tobacco control in Cyprus must address both socioeconomic inequalities in cigarette smoking and high regular HTP use among younger adults.

• The high prevalence of dual/poly-use and low use of cessation support highlight the need for stronger surveillance, youth-focused prevention and better access to evidence-based quitting support.