The decline of cigarette smoking among adolescents and young adults in Germany and the rising relevance of waterpipes, e‑cigarettes and e‑hookahs

Abstract

Background: National and international studies indicate that despite the decline in the consumption of traditional tobacco cigarettes, the consumption of other products, such as waterpipes (or hookahs), e‑cigarettes or e‑hookahs (a variant of e‑cigarettes), may be increasing. In addition to the long-term change in smoking behaviour, this article examines how the prevalence of smoking tobacco cigarettes, waterpipes, e‑cigarettes and e‑hookahs in adolescents and young adults in Germany has developed between 2007 and 2016. Methods: Data are based on representative surveys on substance use among adolescents and young adults between the ages of 12 and 25 conducted by the Federal Center for Health Education (BZgA) from 1973 to 2016. Age- and gender-specific trends of the proportion of those who describe themselves as smokers are shown. Additionally, trends of single and combined 30-day prevalence of consumption of tobacco cigarettes, waterpipes, e‑cigarettes and e‑hookahs are presented and tested for significance. Results: Between 2007 and 2016, the decline in the proportion of adolescents and young adults who call themselves smokers and the decline of 30-day prevalence of consumption of tobacco cigarettes continued. At the same time, the consumption of waterpipes is rising in young adults and the consumption of e‑cigarettes is rising in young men. Among adolescents, the exclusive use of waterpipes, e‑cigarettes or e‑hookahs was more widespread in 2016 than the exclusive consumption of tobacco cigarettes. Discussion: In comparison to tobacco cigarettes, the consumption of waterpipes, e‑cigarettes and e‑hookahs is becoming increasingly important among adolescents and young adults. Thus, these products must also be considered in the planning and design of preventive measures for the prevention of smoking.