THE USE OF DIFFERENT TOBACCO AND RELATED PRODUCTS, 
WITH AND WITHOUT FLAVOURS, AMONG 15-YEAR-OLDS IN SLOVENIA
Helena KOPRIVNIKAR1*, Tina ZUPANIC1
1National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia
Received: Jan 12, 2016
Accepted: Aug 29, 2016
Original scientific article
Background. Different tobacco and related products, like waterpipe, e-cigarettes, are gaining popularity 
among adolescents in different countries; the data for Slovenia is currently limited. The purpose of this paper 
is to present the latest data on the use of different tobacco and related products, with or without flavours, 
among 15-year old students in Slovenia.
Methods. Data for 15-year-old students were drawn from 2014 Slovene database of the cross-national survey 
Health Behaviour in School-Aged Children. The survey sample was selected with stratified two-stage sampling 
method. The survey was performed in schools with a self-administered web questionnaire. The survey 
questionnaire included international compulsory, selected optional and national questions, all on a variety of 
topics related to youth health behaviour.
Results. 25.2% of 15-year-old students reported current (past 30-day) use of any tobacco related product, 
mainly cigarettes (93.1% of users), followed by waterpipe (11.7%) and cigars, cigarillos and pipes (9.4%). 
Exclusive use of unconventional products is low (5.1% of users). 85.5% of users of any product used one product, 
48.5% of users used products with flavours. The use of different products, one or more products, and flavoured 
products was related to gender.
Conclusion. A comprehensive tobacco control and prevention must address all tobacco and related products.
Uvod. Med mladostniki v tujini postajajo vedno bolj popularni različni tobačni in s tobakom povezani izdelki, 
kot so vodne pipe ali elektronske cigarete, za Slovenijo pa imamo o tem na voljo omejene podatke. Namen 
prispevka je prikaz najnovejših podatkov o uporabi tobačnih in s tobakom povezanih izdelkov z okusom ali brez 
njega med všolanimi petnajstletniki v Sloveniji.
Metode. Uporabili smo podatke za všolane petnajstletnike iz slovenske podatkovne baze presečne raziskave Z 
zdravjem povezana vedenja v šolskem obdobju 2014. Za oblikovanje vzorca je bilo uporabljeno dvostopenjsko 
stratificirano vzorčenje. Anketiranje je potekalo v šolah s pomočjo spletne ankete. Vprašalnik obsega niz 
mednarodnih obveznih in opcijskih vprašanj ter nekaj nacionalnih vprašanj o različnih področjih z zdravjem 
povezanih vedenj mladostnikov.
Rezultati. O uporabi vsaj enega tobačnega ali s tobakom povezanega izdelka v zadnjih 30 dneh je poročalo 
25,2% všolanih petnajstletnikov, največ o uporabi cigaret (93,1% uporabnikov), vodnih pip (11,7%) ter cigar, 
cigarilosov in pip (9,4%). Izključna uporaba nekonvencionalnih izdelkov je nizka (5,1% uporabnikov). 85,5% 
uporabnikov kateregakoli izdelka je uporabljalo en izdelek, 48,5% izdelke z dodanimi okusi. Uporaba različnih 
tobačnih in s tobakom povezanih izdelkov, enega ali več izdelkov in izdelkov z dodanimi okusi se je razlikovala 
med spoloma.
Zaključek. Celovit program nadzora nad tobakom in preprečevanje rabe tobaka morata vključevati vse različne 
tobačne in s tobakom povezane izdelke.
ABSTRACT
Keywords: 
smoking, tobacco, 
adolescents
IZVLEČEK
Ključne besede: 
kajenje, tobak, 
adolescenti
*Corresponding author: Tel: ++ 386 1 2441 469; E-mail: helena.koprivnikar@nijz.si
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
74
UPORABA RAZLIČNIH TOBAČNIH IN S TOBAKOM POVEZANIH IZDELKOV 
Z OKUSOM ALI BREZ NJEGA MED PETNAJSTLETNIKI V SLOVENIJI
Koprivnikar H, Zupanic T. The use of different tobacco and related products, with and without flavours, among 15-year-olds in Slovenia. Zdr Varst 2017; 56(2): 74-81
© Nacionalni inštitut za javno zdravje, Slovenija. 
1 INTRODUCTION
Tobacco use is the leading preventable cause of death in 
Slovenia (1), and one of the leading risk factors in terms 
of attributable DALYs (2). Smoking is initiated mainly by 
adolescents; 84.7% of ever smokers in Slovenia, aged 35-
44, first smoked at 19 years of age or less (3). Although 
data on adolescent prevalence and trends of tobacco 
use in Slovenia is available (4-6), much less is known 
about adolescents’ use of different types of tobacco and 
related products. Different patterns and trends of use 
are present in different countries; in some the situation 
changed extensively in only a few years, which shows the 
importance of a regular surveillance of the use of these 
products (7, 8). In the United States of America (the USA), 
adolescents’ use of electronic cigarettes (e-cigarettes) 
and waterpipe surpassed cigarette use. In 2014, those 
aged 14-18 mostly used e-cigarettes (13.4%) and waterpipe 
(9.4%), followed by cigarettes (9.2%) and cigars (8.2%). 
E-cigarette use tripled and waterpipe use almost doubled 
from 2013 to 2014, while the use of cigarettes and cigars 
equivalently decreased (7). In Canada, where e-cigarettes 
and liquids with nicotine are not approved for sale, 2.6% 
of 15-19-year-olds reported current use of e-cigarettes 
in 2013 (9). In Poland, 29.9% of 15-19-year-olds used 
e-cigarettes in 2013-2014, the share increased from 5.5% in 
2010-2011 (8). In Finland, 2.0% of 12-18-year-olds in 2013 
reported the use of e-cigarettes more than 20 times in 
life (10), while in the United Kingdom, 3.0% of 11-16-year-
olds reported at least monthly use of e-cigarettes in 2014 
(11). Waterpipe is also gaining popularity among youth 
(7, 12). Current waterpipe use was reported by 10.2% of 
15-year-olds in Sweden in 2011 (13), 34.9% of 15-year-olds 
in Estonia in 2006 (14), 22.4% of 13-15-year-olds in Czech 
Republic, and 13.8% of 13-15-year-olds in Slovakia in 2011 
(15). Hand-rolled cigarettes are another popular product 
among youth (16, 17). In Croatia, 13% of 13-15-year-olds 
smoked hand-rolled cigarettes in 2011, in Slovakia 6.2% 
in 2011, and in Italy 8.2% in 2010 (15). In Canada in 2008-
2009, 24.2% of current smokers, aged 14-18 years, smoked 
hand-rolled cigarettes (16). Flavours in tobacco and 
related products increase the appeal of these products to 
youth (18). In Poland in 2009-2010, 12.3% of 15-19-year-
olds used flavoured cigarettes (19). In Canada, 50.0% of 
14-18-year-old users of any tobacco product reported the 
use of products with flavours in 2012/13, and in the USA, 
73.0% in 2014 (both countries have already introduced 
bans on flavours (excluding menthol) in selected tobacco 
products) (20, 21). Limited data also shows high shares 
of adolescents reporting current use of more than one 
tobacco or related product. In the USA in 2014, 51.3% of 
14-18-years-old users of any product used more than one 
product (7).
The latest data on the use of different tobacco and 
related products among Slovene youth is available from 
2011/2012 (15, 17). The most used products in 15-24 age 
group are manufactured cigarettes, hand-rolled cigarettes 
and waterpipe (92.7%, 18.0% and 3.9% of current users, 
respectively) (17). Among 13-15-year-olds, 23.8% used 
manufactured cigarettes, 10.9% hand-rolled cigarettes, 
9.8% waterpipe, 7.9% cigars, mini cigars or cigarillos, 
and 3.6% chewing tobacco or snus, while the study gives 
no data on the use of e-cigarettes (15). We found no 
published data on the use of flavoured products and more 
than one tobacco and related product among adolescents 
in Slovenia. The aim of this article is to present the most 
recent data on the use of different tobacco and related 
products (with and without flavours), and multiple 
tobacco and related products among 15-year-old students 
in Slovenia, and to explore differences in the use of these 
products by gender, age at smoking initiation, and the 
frequency of current smoking.
2 METHODS
Data for 15-year-old students were drawn from 2014 
Slovene database of the cross-sectional survey Health 
Behaviour in School-Aged Children, carried out on a 
nationally representative sample of 11-, 13- and 15-year-
old students attending schools. The basis for the sample 
were the data from the Ministry of education, science and 
sport about the enrolment and number of classes for the 
school year 2013/2014. The sample was drawn from the 
list of all relevant classes. The primary sampling unit was 
school class; classes were randomly selected. Stratified 
two-stage sampling was used. At the first stage, primary 
and secondary schools were selected, and at the second 
stage, among secondary schools, classes within different 
school programmes were selected (grammar school, 
4-year technical school, middle vocational school and 
lower vocational school). The survey was performed in 
schools with a self-administered web questionnaire from 
3rd to 14th February 2014. The final response rate (based 
on selected classes) was 92.7%. The sampling procedure 
met all international requirements on representativeness, 
so we did not decide to weight the data, despite minor 
differences in gender distribution of the sample in 
comparison to population gender distribution at the 
beginning of the school year. Survey methodology in detail 
is available elsewhere (4). The survey questionnaire 
included international compulsory, selected optional 
and national questions, all on a variety of topics related 
to youth health behaviour (questions on different 
demographic factors, eating habits, weight control and 
body image, physical activity, sedentary behaviour, risk 
behaviour, sexual health, violence and injuries, family 
culture, peer culture, health and wellbeing, school and 
social inequality), including tobacco and related products 
use. Questions on the use of different tobacco and related 
products, flavoured products, the number of cigarettes 
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
75
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
76
To estimate the number of tobacco and related products 
users among 15-year-old students in Slovenia, we used the 
data from Statistical office on the number of 15-year-old 
inhabitants of Slovenia in the first half of 2014 (18.532 
15-year-olds).
All analyses were conducted in IBM SPSS 21. We used the 
Chi-square test (X2) and correlation matrix to examine the 
association and correlation between selected variables; 
the significance level used was 0.05. If estimations are of 
lower accuracy, they are labelled with letters M (standard 
error of share on interval from 5% to 15%) and should be 
used with caution.
3 RESULTS
Our final sample comprised of 4.997 11-, 13- and 
15-year-old students and was representative of the 
whole population of 11-, 13- and 15-year-old students in 
Slovenia. The final response rate was 92.7%. Both genders 
were equally represented (51.0% female, 49.0% male). In 
our final sample, 68.3% of all students attended primary, 
12.9% grammar, 12.1% technical and 6.7% vocational 
schools. The sample of 15-year-old students, analysed 
in this study, consisted of 1.615 pupils, 46.1% male and 
53.9% female. 
Any tobacco or related product use during the last 30 days 
was reported by 25.2% of 15-year-old students (Table 1). 
The use of the majority of different types of tobacco and 
related products was related to gender.
smoked in the last 30 days, and age at first cigarette 
smoking were answered only by 15-year-old students. 
The use of different tobacco and related products was 
assessed by a national question, asking about the use of 
different products during the last 30 days (manufactured 
cigarettes, hand-rolled cigarettes, cigarillos, cigars, 
pipes, smokeless tobacco, e-cigarettes, waterpipe, 
others). For a part of our analysis, we merged products 
in two categories, namely conventional (cigarettes, 
cigarillos, cigars, pipes) and unconventional (smokeless 
tobacco, e-cigarettes, waterpipe, others) products. 
The use of flavoured products was assessed by a national 
question, asking about the use of products with flavours 
during the last 30 days (yes, I used only products with 
flavours; yes, I used products with and without flavours; 
no; I do not know). The share of those using flavoured 
products was calculated by combining the first two 
answers.
The number of cigarettes smoked during the last 30 days 
was assessed by an optional question (none; less than 
one a week; less than one a day; 1-5 a day; 6-10 a day; 
11-20 a day; more than 20 a day). The age at cigarette 
smoking initiation (more than one puff) was assessed by 
a compulsory question (never; 11 or earlier; 12; 13; 14; 
15 and 16 years of age or more). Both questions were 
used or adapted from the European School Survey Project 
on Alcohol and Other Drugs (ESPAD) survey. The data on 
current tobacco smoking was acquired by a compulsory 
question (every day; at least once a week, but not every 
day; less than once a week; I do not smoke). 
Table 1. The use of different tobacco and related products during the last 30 days among all 15-year-old students (n=1558) and users 
of any product (n=392).
*the sum of shares for each product exceeds the share of users of any product as one person can use more than one product
**shares for each product together exceed 100% as one person can use more than one product 
any product
manufactured cigarettes
hand-rolled cigarettes
waterpipe
cigarillos, cigars, pipes
e-cigarettes
smokeless tobacco
other
392
300
162
46
37
14
11
6
182
118
94
31
25
11
8
4
210
182
68
15
12
3
3
2
25.2%
19.3%
10.4%
3.0%
2.4%
0.9%
0.7%
0.4%
25.6%
16.6%
13.2%
4.4%
3.5%
1.5%
1.1%
0.6%
24.8%
21.5%
8.0%
1.8%
1.4%
0.4%
0.4%
0.2%
100.0%
76.5%
41.3%
11.7%
9.4%
3.6%
2.8%
1.5%
100.0%
64.8%
51.6%
17.0%
13.7%
6.0%
4.4%
2.2%
100.0%
86.7%
32.4%
7.1%
5.7%
1.4%
1.4%
1.0%
0,869
0.016
0.001
0.003
0.007
0.013
0.070
0.299
4670
3577
1927
556
445
167
130
74
n n n% 
among 
all 15-
year-old 
stu-
dents*
% 
among 
all 15-
year-old
male 
stu-
dents*
% 
among 
all 15-
year-old
female 
stu-
dents*
% 
among 
users**
% 
among 
users**
% 
among 
users**
Girls
p 
(diff. 
among 
genders 
for all 
15-year-old 
students)
Estimated 
number 
of users 
among 
15-year-olds 
of both  
genders
BoysBoth genders
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
77
Regardless of the type, cigarettes were used by 93.1% of 
all 15-year-old students that used any tobacco or related 
product, by 87.9% of boys and 93.3% of girls. The number 
of cigarettes smoked during the last 30 days (Figure 1) 
was not related to gender (p=0.455).
Table 2.
Table 3.
Figure 1.
The use of one or more tobacco and related products during the last 30 days among all 15-year-old students (n=1558) and 
users of any product (n=392).
The use of one or more tobacco or related products 
among 15-year-old students who are current smokers 
by the frequency of smoking tobacco.
The number of cigarettes smoked during the last 30 
days among 15-year-old students who are cigarette 
smokers (n=340).
one
two or more 
All
one 
two or more
Boys
one 
two or more
Girls
one 
two or more
335
57
144
38
191 
19 
21.5%
3.7%
20.3%
5.4%
22.5%
2.2%
85.5%
14.5%
168
29
76
22
92
7
 
85.3%
14.7%
77.6%
22.4%
92.9%
7.1%
74
15
27
9
47
6
 
83.1%
16.9%
75.0%M
25.0%M
88.7%
11.3%
0.643
0.756
0.372
79.1%
20.9%
91.0%
9.0%
3984
686
n n n% 
among all 
15-
year-old 
stu-dents*
% 
among all 
15-
year-old
male stu-
dents*
% 
among all 
15-
year-old
female 
stu-dents*
% 
among 
users**
% 
among 
users**
% 
among 
users**
Girls
Estimated 
number 
of users 
among 
15-year-olds 
of both  
genders
BoysBoth genders
p
Smoking tobacco 
weekly or more 
often
n n% %
Smoking tobacco  
less than weekly
Correlation matrix indicates weak negative correlation 
between the age at smoking initiation and the number 
of cigarettes smoked during the last 30 days (-0.219, 
p=0.01). It indicates that the number of cigarettes smoked 
during the last 30 days decreases by increasing the age at 
smoking initiation. 
Weekly or daily smoking is not related to the type 
of cigarettes used when comparing those using only 
manufactured cigarettes with those using hand-rolled 
cigarettes only or in combination with manufactured 
cigarettes (weekly smoking: p=0.052; daily smoking: 
p=0.092).
When considering manufactured and hand-rolled 
cigarettes as one product, the majority of 15-year-
old students that used any tobacco or related product 
(85.5%) used one product (Table 2); the use was related 
to gender (p=0.001). The most frequent combinations 
used were cigarettes with waterpipe or e-cigarette. Only 
one 15-year-old student used solely e-cigarettes, others 
used e-cigarettes and other products (12 of 14 e-cigarette 
users also smoked cigarettes). 15 of 46 waterpipe users 
used solely waterpipe, others used also other products 
(29 of 31 waterpipe users also smoked cigarettes).
The use of one or more tobacco and related products is 
not linked to the frequency of current smoking (Table 
3); however, it is associated with the age at smoking 
initiation (Table 4). 
M-less precise estimate 
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
78
Table 4.
Table 7.Table 6.
The use of one or more tobacco or related products 
among 15-year-old students who are ever smokers by 
the age of smoking initiation.
The use of flavoured tobacco and related products 
during the last 30 days among 15-year-old students 
who are current smokers by the frequency of 
smoking tobacco.
The use of flavoured tobacco and related products 
during the last 30 days among 15-year-old students 
and users of any product.
M-less precise estimate 
All
one 
two or more
Boys
one 
two or more
Girls
one 
two or more
All
Boys
Girls
Flavoured 
products
 
114
29
43
21
71
8
84
38
46
41
13
28
44.2%
40.0%M
48.4%M
50.0%M
39.4%M
57.1%M
189 75 114
 
79.7%
20.3%
67.2%M
32.8%M
89.9%M
10.1%M
48,5 40,3 55,9
 
213
26
95
16
118
10
 
89.1%
10.9%
85.6%
14.4%
92.2%
7.8%
p
p
p
First smoked 
cigarettes at 13 
or less
Smoking tobacco 
weekly or more 
often
All
n
n
n
n
n
n n
%
%
%
%
%
% %
First smoked 
cigarettes at 14 
or more
Smoking tobacco 
less than 
weekly
Boys Girls
0.011
0.379
0.951
0.321
0.004
0,002
0.566
A vast majority of 15-year-old students used conventional 
products (Table 5) and the use was not related to gender.
48.5% of 15-year-old students that used any product used 
products with flavours; the use was related to gender 
(Table 6), but not to the frequency of smoking (Table 7) 
or age at smoking initiation (Table 8).
Table 5. The use of conventional and unconventional products during the last 30 days among all 15-year-old students (n=1558) and 
users of any product (n=392).
*shares for each group together exceed the share of users as one person can use more products 
**shares for each product together exceed 100% as one person can use more products
conventional 
unconventional 
only unconventional 
372
66
20
167
44
15
205
22
5
23.9%
4.2%
1.3%
23.5%
6.2%
2.1%
24.2%
2.6%
0.6%
94.9%
16.8%
5.1%
 91.8%
24.2% 
8.2% 
97.6% 
10.5% 
0.2% 
0.763
<0.001
0.008
4429
778
241
n n n% 
among 
all 15-
year-old 
stu-
dents*
% 
among 
all 15-
year-old
male 
stu-
dents*
% 
among 
all 15-
year-old
female 
stu-
dents*
% 
among 
users**
% 
among 
users**
% 
among 
users**
Girls
p 
(diff. 
among 
genders 
for all 
15-year-old 
students)
Estimated 
number 
of users 
among 
15-year-olds 
of both  
genders
BoysBoth genders
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
79
Table 8. The use of flavoured tobacco and related products 
during the last 30 days among 15-year-old students 
who are ever smokers by the age of smoking 
initiation.
All
Boys
Girls
61
22
39
120
47
73
44.5%
36.7%M
50.6%M
50.6%
41.2%
59.3%
p
First smoked 
cigarettes at 13 
or less
n n% %
First smoked 
cigarettes at 14 
or more
0.255
0.559
0.228
4 DISCUSSION
In Slovenia, a vast majority of 15-year-old students 
that are users of any tobacco or related products use 
cigarettes (mostly manufactured cigarettes, but hand-
rolled cigarettes are also used substantially), followed 
by waterpipe and later by cigars, cigarillos and pipes. A 
vast majority therefore uses conventional products. Every 
sixth student uses unconventional products, whilst the 
exclusive use of unconventional product is low (mainly 
the exclusive use of waterpipe). There are significant 
differences in the use of different types of tobacco and 
related products between genders; girls are more likely 
to use manufactured cigarettes, while boys are more 
likely to use hand-rolled cigarettes, waterpipe, cigarillos, 
cigars and pipes, and e-cigarettes. Almost half of those 
that use any product – significantly more girls than boys – 
use products with flavours. Approximately every seventh 
15-year-old student who uses any product uses more 
than one product – significantly more boys than girls and 
significantly more those that started smoking cigarettes 
earlier. Most frequent combinations are cigarettes and 
waterpipe or cigarettes and e-cigarettes. 
Only limited comparisons on current use of different 
tobacco and related products with other studies are 
possible mainly due to different age groups, the range 
of monitored products, definitions of use and a limited 
number of published studies with nationally representative 
samples. When comparing our results to results of other 
available studies among youth in Slovenia, we find the 
same order of mostly used products, while shares differ 
(15, 17), which is most likely attributable to the difference 
in age groups of respondents, different year of the survey 
and methodological differences. The comparison with 
adult population in Slovenia shows lower shares of the use 
of manufactured cigarettes among 15-year-old students, 
while shares of the use of all other tobacco and related 
products are higher in students. The use of more than 
one product among adult population is around half of the 
use of more than one product among 15-year-old students 
(17). Adolescents are obviously prone to use different and 
unconventional products and more than one product. 
There is no data available to compare the use of flavoured 
products. The comparison of available data for similar 
age groups in other countries show that shares of the use 
of waterpipe, e-cigarette and unconventional products in 
general and more than one product are currently most 
likely lower in Slovenia (7-15, 22). 
The use of any product containing nicotine is problematic 
in adolescence, which is a sensitive developmental 
period of enhanced clinical vulnerability to nicotine. 
Adolescents are more likely than adults to become 
addicted to nicotine; nicotine acts as a gateway to 
other substances, affects brain development and has 
long-term negative consequences on cognition (22, 23). 
Adolescents that might never use conventional products 
are using unconventional products (8-11, 14). Those could 
act as a gateway to conventional tobacco products use 
by exposing youth to nicotine, and increase the overall 
number of youth initiating tobacco use. A limited number 
of longitudinal studies on waterpipe and e-cigarette 
ever users shows an increased risk of later conventional 
tobacco use initiation in adolescents (25-27). Flavoured 
products are tobacco industry’s innovation to increase 
the appeal of smoking in youth. They can promote youth 
smoking initiation and help young occasional smokers to 
become daily smokers by reducing or masking the natural 
harshness and taste of tobacco smoke (18). Young people 
who start smoking menthol cigarettes are at greater risk 
of progression to regular smoking and nicotine addiction 
than those who start smoking non-menthol cigarettes 
(28). Flavours are also one of the most important reasons 
for increasing the popularity of waterpipe (12) and 
e-cigarettes among youth (29). Hand-rolled cigarettes are 
popular among youth also due to lower prices compared 
to manufactured cigarettes (30, 31). Some studies 
indicate that youth using hand-rolled cigarettes are more 
likely heavier and more frequent smokers (16, 32), more 
addicted to nicotine and less likely considering quitting 
smoking, when compared to users of manufactured 
cigarettes (32). Our study does not show more weekly or 
more daily smoking among 15-year-old students that use 
hand-rolled cigarettes compared to those that use only 
manufactured cigarettes. Studies also indicate increased 
nicotine addiction in users of more than one product (33). 
All this underlines the importance of continuous 
surveillance, timely implementation and strict 
enforcement of all necessary measures to prevent 
children and adolescents from using all nicotine containing 
products, and the inclusion of all different products in 
prevention and cessation programmes. Products gaining 
popularity among youth are currently mostly unregulated 
or inadequately regulated, available to minors and/
or more affordable, also in Slovenia. The World Health 
Organization recommends regulation for waterpipe and 
e-cigarettes as for any other tobacco product (34, 35). 
10.1515/sjph-2017-0010 Zdr Varst 2017; 56(2): 74-81
80
Our research is the first in Slovenia to give insight into the 
use of different tobacco and related products, including 
e-cigarettes, flavoured products and the use of more than 
one product, on a representative sample of adolescents 
in schools. Our study has some limitations. The cross-
sectional design of the study does not allow for any 
conclusions on causality or chronology. Under-reporting 
of smoking and the use of different products is possible. 
We collected data only from 15-year-olds that attend 
school and we can generalize data only to the group 
of 15-year-old students. We did not ask about nicotine 
content of liquids for e-cigarettes and the use of tobacco 
(rather than herbal products) for waterpipe. Regardless 
of limitations, our study offers valuable data for tobacco 
control and prevention.
5 CONCLUSIONS
15-year-old students in Slovenia currently use mostly 
conventional products, very often they use products with 
flavours and mostly they use only one product. However, 
situation in other countries shows that a pattern of 
use can change quickly, especially due to non-existent 
or inadequate regulation of certain products or their 
characteristics, such as flavours. Regular surveillance, 
addressing all different products in prevention and 
cessation programmes, and timely and effective 
regulation, comparable for all different products, 
combined with strict enforcement are necessary for 
effective prevention of the use of all products containing 
nicotine among youth in Slovenia.
CONFLICT OF INTEREST
The authors declare that no conflict of interest exists.
FUNDING 
The study was financed by the Ministry of Health of the 
Republic of Slovenia.
ETHICAL APPROVAL
The study was approved by the Republic of Slovenia 
National Medical Ethics Committee on 29 October 2013 
under the number 139/10/13.
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