E-cigarettes and heat-not-burn products: representative data on consumer behaviour and associated factors in the German population (the DEBRA study)

Abstract

Background: Electronic cigarettes (ECs) and heat-not-burn (HNB) devices are relatively new products that are increasingly used alternatively or complementary to ordinary tobacco products. Objectives: To analyse current data from the German Study on Tobacco Use (DEBRA) regarding the prevalence of EC and HNB device use and associated socioeconomic factors and smoking behaviour; compare reasons for EC use between adolescents and adults; describe the self-perceived risk of HNB devices. Material and methods: DEBRA is an ongoing, representative, face-to-face household survey of the population aged 14 years and older. We analysed data from the first nine waves (June/July 2016 to October/November 2017; n = 18,415) for the current study. Results: During the observation period, 1.9% (95% confidence interval (CI) = 1.7–2.2%) of the German population used ECs (2.8% of the 14- to17-year-olds) and 74.5% (95% CI = 69.4–79.2%) of current EC users also smoked tobacco (“dual use”). Three-quarters of adolescents used ECs mainly “for fun”, whereas reasons for use among adults related more to smoking tobacco (e. g., less harmful, to quit smoking). Among current smokers and recent ex-smokers (<12 months smoke-free), 0.3% (95% CI = 0.09–0.64%) currently used HNB devices, and 6.0% (95% CI = 5.0–7.2%) had ever used them. Consumption of HNB products increased with increasing education and income. The majority perceived HNB products as somewhat (41.0%, n = 25) or much (14.8%, n = 9) less harmful, and 37.7% (n = 23) as equally harmful compared with tobacco cigarettes. Conclusions: In Germany, ECs are mainly consumed as “dual use” together with tobacco. Consumption of HNB products currently occurs at a very low rate and is relatively more common among smokers with higher education and income. It remains important to monitor the use of new electronic inhalation products in the total population and in relevant subgroups.