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IQOS, the Philip Morris International (PMI) flagship heated tobacco product (HTP), is now available in 82 countries.1–3 According to PMI’s 2023 fourth-quarter results, IQOS has overtaken Marlboro on net revenues.4 Scant research is available on youth’s HTP perceptions, including in Guatemala. Among adolescents aged 16–19 years in England, Canada and the USA, susceptibility to trying IQOS has been found to be higher than for cigarettes.5 In Guatemala, adolescent HTP use has been found to be low, yet susceptibility to use is high, suggesting that tobacco use prevention strategies should also include HTPs.6 7 Furthermore, Guatemala faces the challenge of increased accessibility for adolescents and exposure to unregulated tobacco marketing.8