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BACKGROUND: Tobacco harm reduction aims to reduce the health burden of smoking by providing smoke-free alternatives, such as heated tobacco products (HTPs), for adults who would otherwise smoke. Philip Morris Products S.A. has been commercializing the Tobacco Heating System (_THS_) nationally in Italy since 2016. This study aims to measure the prevalence and patterns of use of tobacco and nicotine-containing products (TNPs) in Italy between 2018 and 2024. METHODS: This study was a repeated cross-sectional survey that comprised a representative General Adult Population Sample (GAPS) and a _THS_ User Sample (TUS) of the adult population in Italy, from 2018 to 2024. The last GAPS survey (N ⁓ 3000), conducted between 2023-2024, used a three-stage stratified random sampling method and was conducted face-to-face using computer-assisted personal interviews. The TUS survey (N ⁓ 1000) was an online survey among randomly selected _THS_ users registered in the PMI Italy’s database of adult purchasers. Both survey questionnaires collected data on current, past, and never TNP use, including prevalence, frequency, intensity, history, patterns, and quitting of TNP use. RESULTS: The GAPS survey data showed that in 2024 current TNP use prevalence among Italian adults was 25.8%, unchanged from 25.7% in 2018, with cigarette smoking being the most used TNP over time. Between 2018 and 2024, cigarette smoking prevalence decreased from 24.3% in 2018 to 22.4% in 2024, while HTP use prevalence increased from 0.7% to 4.1% respectively, with _THS_ (2.9%) accounting for approximately 70% of HTPs used in 2024. At the same time, _THS_ initiation, relapse, and reinitiation among adult never and former TNP users in the GAPS remained low (0.1%) across the survey periods. The TUS survey data showed that the proportion of _THS_ users who did not smoke increased from 61.4% in 2018 to 75.9% in 2024. In line with previous years, the TUS survey data showed that 95.2% of _THS_ users had a history of TNP use before switching to _THS_. Many _THS_ users reported perceived improvement in terms of coughing (68.8%), breathing (68.3%), oral health (64.1%), overall physical health (61.7%), and overall health (61.6%) after switching to _THS_. CONCLUSIONS: Between 2018 and 2024, the prevalence of TNP use among Italian adults remained stable. Over time, there was an increase in the adoption of HTPs, primarily _THS_, while the prevalence of cigarette smoking decreased. _THS_ uptake among adult never and former TNP users has remained low over time. Data also show that the majority of _THS_ users did not smoke and that a large proportion of _THS_ users reported perceived improvements in health and functioning-related benefits after switching to _THS_. Continued surveillance of long-term HTP use in Italy remains essential.