Two decades of changes in tobacco and nicotine product use among Ukrainian adolescents, 2005-2023: Prevalence patterns in the context of policy and crisis

OBJECTIVES: In the context of tobacco control reforms since 2005 and continued societal disruption in Ukraine, we assessed two-decade trends in tobacco and nicotine product (TNP) use and the association between TNP use and emotional well-being among adolescents. STUDY DESIGN: Pooled cross-sectional analysis of four Global Youth Tobacco Survey rounds (2005, 2011, 2017, 2023). METHODS: Students in selected classes (typically grades 7-11) completed standardized school-based surveys. Measures included current TNP use, a 0-4 TNP count (2017/2023), and well-being based on the adapted World Health Organization Five Well-Being Index (WHO-5). Survey-weighted prevalence estimates were obtained using multinomial logistic regression. RESULTS: Current cigarette smoking significantly declined from 24.5% (95% CI 21.8-27.4) in 2005 to 7.7% (95% CI 6.2-9.6) in 2017 and then rose to 12.2% (95% CI 9.7-15.3) in 2023 with more moderate-to-heavy use. From 2017 to 2023, e-cigarette use remained common (17.4% [95% CI 14.2-21.1] vs 19.2% [95% CI 16.9-21.8]), smokeless tobacco use significantly increased from 2.9% (95% CI 2.1-4.0) to 4.9% (95% CI 3.4-7.2), while heated tobacco product use reached 6.8% (95% CI 5.5-8.5) and nicotine pouch use 2.9% (95% CI 2.1-3.9); poly-use doubled to 4.8% (95% CI 3.2-6.4). Adolescents with low well-being were less likely to report non-use (adjusted 73.4% vs 81.2%) and more likely to report poly-use (9.3% vs 5.0%). CONCLUSIONS: Ukraine achieved large declines in youth cigarette smoking through 2017, followed by a rebound and diversification into new TNPs, particularly poly-use. Low well-being was associated with higher TNP involvement. Policies should ensure tax and marketing parity across products and strengthen enforcement during periods of crisis. Given the association between low well-being and TNP use, prevention and cessation efforts may also benefit from integration with mental health and trauma-informed support for youth.