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Background: Tobacco cigarettes, e-cigarettes and heated tobacco products can pose different health risks (harm continuum). As current tobacco smokers could benefit from switching to less harmful products, we aimed to assess current smokers' perceived comparative health risks of these three products and to explore associations between risk perceptions and specific user characteristics., Methods: We analysed data from 11 waves (2019-2021; N = 5657 current tobacco smokers) of a representative, cross-sectional household survey conducted in Germany. Associations were assessed with multivariable logistic regression models., Results: 55.2% of smokers (95%CI = 53.8-56.5%) ranked cigarettes as the most harmful product. 36.1% of smokers (95%CI = 34.8-37.3%) perceived e-cigarettes and 33.8% (95%CI = 32.5-35.0%) heated tobacco products as more harmful than cigarettes. Misperceptions that e-cigarettes or heated tobacco products are more harmful to health than cigarettes increased over the 3-year study period and were more common among those with lower educational attainment., Conclusions: Only half of current tobacco smokers in Germany perceive the comparative health risks of cigarettes adequately and such misperceptions have increased recently. As current smokers could benefit most from switching to less harmful products, educational campaigns are needed to inform this group about the health risks of tobacco smoking and the comparative health risks of the various nicotine and tobacco products along the harm continuum., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: We aimed to describe population trends in motivation to stop smoking between 2016 and 2021 in Germany. Furthermore, the aim was to estimate to what extent higher ratings on the validated German version of the Motivation To Stop Scale (MTSS) are associated with sociodemographics, nicotine dependence, past quit attempts, and use of e-cigarettes and tobacco product alternatives., Methods: We used data from the German Study on Tobacco Use: an ongoing repeated cross-sectional face-to-face household survey collecting representative data of the German population every other month since 2016. We analysed data from 18 969 adult current smokers with multivariable ordinal regression and described MTSS scores between 2016 and 2021 (scores 1-7=lowest to highest level of motivation)., Results: The mean MTSS score was 2.04 (SD=1.37) and showed a slight downward trend over time. Younger age, higher level of education, fewer cigarettes per day, more time spent with urges to smoke, a recent quit attempt, no previous waterpipe use and current or past e-cigarette use were associated with higher MTSS scores. The largest effect estimates were observed for at least one quit attempt 0-6 months ago versus no attempt in the past year (OR=7.54; 95% CI 6.78 to 8.40), at least one quit attempt 7-12 months ago versus no attempt in the past year (OR=4.00; 95% CI 3.59 to 4.45) and for current versus never use of e-cigarettes (OR=1.71; 95% CI 1.48 to 1.99)., Conclusions: Recent quit attempts and current use of e-cigarettes were associated with higher motivation to stop smoking in the German population. Actions to boost the general motivation to stop smoking are required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Tobacco dependence is a common comorbidity in patients with COPD (Chronic Obstructive Pulmonary Disease) that negatively affects the course of the disease. However, clinically relevant improvement in COPD can only be achieved by complete and permanent abstinence. Therefore, abstinence from tobacco use is a central therapeutic concept in smoking patients with COPD and requires specific and targeted treatment.After detailed documentation of smoking behaviour and motivational counseling outlining the risks of smoking, all such patients shall be offered a structured therapy for tobacco cessation. There is high-quality evidence for the effectiveness of a combination therapy of behavioral therapy and medication (to treat the withdrawal syndrome). Due to insufficient data, there is currently no recommendation for the use of e-cigarettes as a primary option for a cessation attempt.Smoking is the most important cause of COPD. Smoking cessation is the most effective and cost-efficient single intervention to reduce the risk of developing and progressing COPD., Competing Interests: SA erhielt Forschungsförderung von Boehringer Ingelheim und Honorar für Referententätigkeit von Boehringer Ingelheim, Novartis, AstraZeneca, GSK, Chiesi, Merini. SA ist Leiter der Task Force Tabakentwöhnung der DGP und Mitglied des ABNR.DK erhielt Forschungsförderung vom Bundesministerium für Gesundheit für die Durchführung der Deutschen Befragung zum Rauchverhalten (DEBRA; DRKS00017157 und DRKS00028054) und für die ABC-II-Studie (RCT zum Training von Hausärzten in der leitliniengerechten Kurzberatung zur Tabakentwöhnung; DRKS00012786).AB erklärt: Förderung durch die Bundeszentrale für gesundheitliche Aufklärung, eigenes Tabakentwöhnungsprogramm (Nichtraucher in sechs Wochen). Mitglied im Vorstand des Wissenschaftlichen Aktionskreises Tabakentwöhnung (WAT) e. V. und der Deutschen Gesellschaft für Suchtforschung und Suchttherapie (DG-Sucht) e. V.AH hielt Vorträge für Orion Pharma.SM erklärt: Pfizer (Vortragshonorar + Beratung); Johnson + Johnson (Honorartätigkeit Workshop + Advisory Board); Leitung Raucherambulanz Chemnitz; Wissenschaftlicher Arbeitskreis Tabakentwöhnung; Mitarbeit S3 LL Alkohol und Tabak.DN erhielt Forschungsunterstützung für Forschungsprojekte des Instituts von EU, DFG, BMBF, BMG, DGUV, BGW, Verwaltungs-BG, Bundesarbeitsministerium, Bayerischen Ministerien, Industrie (MAN, FMG, Siemens, Audi), Versicherungen, ADAC/ÖAMTC, Kliniken, Erzbischöfliches Ordinariat, Caritas. DN erhielt Vortragshonorare von Bristol MyersSquibb, Berlin Chemie, Boehringer Ingelheim, Chiesi, GSK, Mundipharma, Novartis, Hexal, Lilly. DN ist Mitglied eines Advisory Boards von Pfizer zur Rauchentwöhnung. DN ist Vertreter der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin im Aktionsbündnis Nichtrauchen (ABNR).KS erhielt Forschungsförderung von der Deutschen Rentenversicherung Bayern Süd und Honorare für Referententätigkeit von AstraZeneca, GSK, Chiesi, Sanofi Genzyme und Berlin-Chemie.HW erklärt, während der letzten 3 Jahre keine wirtschaftlichen oder persönlichen Verbindungen im oben genannten Sinne zu haben.SS begleitet im Rahmen ihrer Tätigkeit beim ÄZQ die Erstellung von Leitlinien methodisch und organisatorisch., (Thieme. All rights reserved.)

Objective: To examine the real-world effectiveness of popular smoking cessation aids, adjusting for potential confounders measured up to 12 months before the quit attempt., Methods: 1,045 adult (≥18y) smokers in England provided data at baseline (April 2015-November 2020) and reported a serious past-year quit attempt at 12-month follow-up. Our outcome was smoking cessation, defined as self-reported abstinence at 12 months. Independent variables were use in the most recent quit attempt of: varenicline, prescription NRT, over-the-counter NRT, e-cigarettes, and traditional behavioural support. Potential confounders were age, sex, social grade, alcohol consumption, and level of dependence (measured at baseline), variables relating to the most recent quit attempt (measured at 12-month follow-up), and survey year., Results: Participants who reported using varenicline in their most recent quit attempt had significantly higher odds of abstinence than those who did not, after adjustment for potential confounders and use of other aids (OR = 2.69, 95 %CI = 1.43-5.05). Data were inconclusive regarding whether using prescription NRT, over-the-counter NRT, e-cigarettes, or traditional behavioural support was associated with increased odds of abstinence (p > 0.05; Bayes factors = 0.41-1.71, expected effect size OR = 1.19), but provided moderate evidence that using e-cigarettes was more likely associated with no effect than reduced odds (Bayes factor = 0.31, expected effect size OR = 0.75)., Conclusions: Use of varenicline in a quit attempt was associated with increased odds of successful smoking cessation. Data were inconclusive regarding a benefit of e-cigarettes for cessation but showed use of e-cigarettes was unlikely to be associated with reduced odds of cessation. Associations between other cessation aids and cessation were inconclusive., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JB has received unrestricted research funding from Pfizer, who manufacture smoking cessation medications. All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We explored past-year quit attempts, cessation methods used, and associations with sociodemographic, smoking, and health-related characteristics among smoking patients with chronic obstructive pulmonary disease (COPD) in Germany. Cross-sectional survey data of 509 past-year smokers (current smokers and ≤12 months abstinent) with COPD (ICD-10 code J44.x and FEV1/FVC <0.70) from 19 pulmonary primary care practices were used. Associations were explored between age, sex, educational qualification, lung function, urges to smoke, psychological distress, and (a) ≥1 past-year quit attempt (yes/no), (b) use of ≥1 evidence-based smoking cessation method (yes/no). Of all patients, 48.5% (n = 247, 95% confidence interval (CI) 44.2-52.9) reported ≥1 past-year quit attempt. Such an attempt was positively associated with the male sex (Odds Ratio (OR) = 1.50, 95% CI 1.01-2.24) and negatively associated with time spent with urges to smoke (OR = 0.69, 95% CI 0.52-0.91). During the most recent past-year quit attempt, one-third of the patients used ≥1 evidence-based smoking cessation method (31.2%, 95% CI 25.4-37.0), which was positively associated with the strength of urges to smoke (OR = 1.62, 95% CI 1.09-2.41). Combined behavioural and pharmacological treatments were used by 4.0% (n = 10, 95% CI 1.6-6.5). Electronic cigarettes were used most frequently (21.5%, 95% CI 16.3-26.6). Although a high proportion of COPD patients in German pulmonary primary care attempt to quit smoking, only a few of them use evidence-based methods as assistance for quitting., (© 2022. The Author(s).)

Introduction: Considering the growing popularity and rapid evolution of e-cigarettes, we examined e-cigarette use and tobacco smoking trends, and e-cigarette consumption patterns (i.e., device type, nicotine level) among adolescents and young adults in Germany., Methods: Data from 26 waves of the German Study on Tobacco Use (DEBRA), a repeated cross-sectional nationwide household survey, were used to explore trends in the prevalence of ever e-cigarette use and tobacco smoking in a sample of adolescents (aged 14-17 years, N = 1,396) and young adults (aged 18-24 years, N = 4,685) between June/July 2016 and Aug/Sept 2020. Among current e-cigarette users (N = 208), consumption patterns were examined. Associations with e-cigarette use were analysed using multivariable regression., Results: Adolescent e-cigarette use increased from 9.2% in 2016 to 16.5% in 2017, decreased in 2018 to 8.3% and then gradually increased to 13.4% by 2020. Adolescent tobacco smoking followed a similar trend. Young adult e-cigarette use rates remained relatively stable at 19.1% on average, while tobacco smoking slowly declined (2016: 44.7%, 2020: 38.5%). More than half of current e-cigarette users used refillable-style e-cigarettes (59.4% adolescents; 68.4% young adults) and also smoked tobacco (62.5% adolescents; 79.4% young adults). About 41.6% of adolescents and 56.0% of young adults vaped with nicotine. Among young adults, men (OR = 1.5; 95%CI: 1.3-1.8) and former (OR = 9.6; 95%CI: 1.1-13.1) and current (OR = 10.7; 95%CI: 8.7-13.2) tobacco smokers were more likely to have vaped., Conclusion: E-cigarette use continues to rise in German adolescents and young adults requiring targeted health interventions and campaigns aimed at preventing and/or reducing use in this population., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Our primary aim was to assess-in the German population-the effectiveness of e-cigarettes (ECs; with or without nicotine), nicotine replacement therapy (NRT), and no use of evidence-based aids in smoking cessation., Methods: Analysis of cross-sectional data from a representative survey of the population (age 14-96 years) conducted in 2016-2021. All current smokers and recent ex-smokers (< 12 months since quitting) who had made ≥ 1 attempt to quit in the past 12 months (n = 2740) were included. They were asked about use of cessation aids in their most recent quit attempt and their current smoking status., Results: Two hundred thirty-nine respondents had used ECs, 168 NRT, and 2333 no aid. After adjustment for potential confounders, the odds of abstinence were 1.78 times higher for smokers who had used ECs in their quit attempt than in the group that had used no aids (95% confidence interval [1.09; 2.92]; p = 0.02) and 1.46 times higher than in the NRT group ([0.68; 3.13]; p = 0.34, Bayes factor = 1.26). Compared with the unaided group, the odds of abstinence were 2.34 times higher ([1.21; 4.53]; p = 0.01) in the subgroup using ECs with nicotine and 1.48 times higher ([0.68; 3.26]; p = 0.33) in the subgroup using ECs without nicotine. The unadjusted abstinence rates in people who had started their quit attempt > 6 months earlier were 15.6% [9.4; 23.8] in the ECs group and 13.8% [7.3; 22.9] in the NRT group., Conclusion: In Germany, use of ECs in an attempt to quit smoking is associated with a higher rate of abstinence than attempting to quit unaided.

Background: Recreational cannabidiol (CBD) is frequently promoted as a medicinal or therapeutic cannabis product worldwide. Nationwide population-based data on awareness and use of recreational CBD are currently lacking., Objective: This study estimates the prevalence of recreational CBD awareness and use among the population in Germany. It also explores potential associations with socio-demographic characteristics, tobacco smoking, and e-cigarette use., Methods: We used data from a cross-sectional household survey (German Study on Tobacco Use, DEBRA) fielded across two waves in October-November 2020 and February-March 2021. Data were collected using computer-assisted face-to-face interviews among participants aged ≥14 years (n = 4026). Outcome variables were CBD awareness (yes/no) and CBD ever use (yes/no). The sample was weighted to ensure representativeness of the prevalence estimates. Associations with socio-demographic variables, tobacco smoking, and e-cigarette use were assessed using multivariable logistic regression., Results: Approximately half of the population in Germany (48.3%, 95% CI: 46.8-49.9) was aware of recreational CBD products, and 4.3% (95% CI: 3.7-5.0) had ever used them (including 1.1% current users). Awareness was associated with younger age, higher education levels, female sex, living in urban regions, no migration background, tobacco smoking, and e-cigarette use. Ever use was associated with higher education levels, living in urban regions, tobacco smoking, and e-cigarette use., Conclusions: Awareness of recreational CBD products is high but ever use is currently low in Germany. Given the uncertain legal framework regarding the marketing of recreational CBD products, the changing retail landscape, and potential harms of CBD use, structured monitoring is warranted for public health purposes.

Introduction: Smoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success., Methods: We analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) - a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders., Results: Of all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77-0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73-0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08-1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success., Conclusions: In the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities., Competing Interests: Declaration of Competing Interest SK and DK have no conflict of interest to declare. JB received unrestricted research funding from Pfizer, who manufacture smoking cessation medications. All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Waterpipes (WP) have a long tradition in certain regions of the world, and their use has been increasing worldwide. Current data on the use of WP in different subgroups of the German population are missing., Objective: To estimate the current prevalence of WP use and associated socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour in the German population aged ≥14 years; to describe the frequency of use and starting age in current WP users., Methods: We analysed data from waves 13-18 (June/July 2018-April/May 2019; N = 12,220) of the German Study on Tobacco Use (DEBRA) - a representative, computer-assisted national household survey. Associations of socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour were assessed with multivariable logistic regression models., Results: A total of 1.8% (n = 217) (95% confidence interval (CI) = 1.5%-2.0%) of the population were current WP users, 13% (n = 1618) (95% CI = 12.3%-13.5%) were ever users. Adjusted multivariable logistic models showed that people with migration background, male sex, younger age, and those who were smokers or used e-cigarettes, were more likely to use a WP. Among current WP users, 15.2% (n = 33) (95% CI = 10.7%-20.7%) had started to use WP at the age of 26 or older, and 23.0% (n = 50) (95%CI = 17.6%-29.2%) had used WP at least once a week or almost daily in the last month., Conclusions: In Germany, the use of WP is popular and most strongly associated with migration background and use of tobacco and e-cigarettes. These aspects should be considered when designing future target group-specific prevention strategies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: In Germany, cannabis is the most widely used illicit drug, and inhalation together with tobacco is most popular. However, it has been described that electronic cigarettes (ECs) are being used to vaporize cannabis (extract). No current data on EC cannabis use in the German population are yet available. Objectives: This study examines the prevalence of EC cannabis consumption for mood changing effects among current EC users, and associated consumer characteristics in Germany. Methods: We used data from the German Study on Tobacco Use (period: 8/2016-01/2019, DEBRA, www.debra-study.info), a nationally representative household survey. EC cannabis use for mood-changing effects was assessed in 504 current EC users (aged ≥ 18 years) of the total sample ( N  = 32,678). Ever use was defined by: (1) occasional or regular use, or (2) experimental consumption. Associations with socio-demographic consumer characteristics and tobacco smoking were analyzed using multivariable regression analyses. Results: Amongst current EC users, 7.2% had ever vaporized cannabis: 2.3% (95%CI = 1.2-3.9) reported occasional or regular use (1) and 4.8% (95%CI = 3.2-7.1) reported experimental use (2). Age was associated with ever EC cannabis use: highest prevalence rates were found among 18-24-year-olds: 6.5% (95%CI = 2.3-13.1) (1) and 8.0% (95%CI = 3.7-15.8) (2), respectively. The majority (90.2%) of ever EC cannabis users were current tobacco smokers. Conclusions: One in 14 current EC users in Germany has ever vaporized cannabis for mood-changing reasons, and almost all EC cannabis consumers also smoke tobacco. Highest usage rates can be observed among young adults. Hence, trends of EC drug misuse need to be monitored consequently, particularly in young people.

Background: The German federal parliament is discussing the implementation of a comprehensive tobacco advertising ban and whether that ban should include alternative nicotine delivery systems (ANDSs), such as e‑cigarettes and tobacco heaters. It would be important to know which outcome the general population, and in particular the users of tobacco/ANDSs, would prefer., Objective: Assessing public support for a comprehensive advertising ban on ANDSs in the German population, and particularly in tobacco and ANDSs users., Material and Methods: The German Study on Tobacco Use ("Deutsche Befragung zum Rauchverhalten", DEBRA) is an ongoing, representative household survey of persons aged 14 years and older. Data from the June/July 2019 survey wave (n = 2019) were analysed. Participants were interviewed regarding their tobacco smoking status and ANDS use, sociodemographic factors, and their support of an advertising ban on ANDSs. Prevalence rates and associations (odds ratio, OR) between support and sociodemographic factors or use of tobacco/ANDSs are reported., Results: Of the population, 57.0% (95% confidence interval (95%CI) = 54.7-59.1%) support a ban on ANDS advertising; 11.1% (95%CI = 9.8-12.6%) reject it. There is support for the ban from 46.0% (95%CI = 42.2-49.9%) of current tobacco smokers and 42.7% (95%CI = 35.9-49.6%) of ANDS users. Ex-smokers show the highest rates of support (64.8%, 95%CI = 58.9-70.3%). Acceptance among never- and ex-smokers is higher than among current smokers (adjusted OR 2.06, 95%CI = 1.64-2.59 and OR 1.65, 95%CI = 1.23-2.21)., Conclusions: The majority of the German population supports a comprehensive advertising ban on ANDSs. Tobacco smokers and ANDS users are also more in favour of than against such a ban. Thus, only little resistance will be expected within the population if a comprehensive tobacco advertising ban, as currently discussed in parliament, includes e‑cigarettes and heated tobacco products.

Background and Aims: Understanding whether and how far smokers' characteristics influence the effectiveness of treatment may be important for tailoring recommendations on cessation aids to those most likely to help the user achieve abstinence. This study aimed to estimate the effectiveness of commonly used smoking cessation aids and test whether their effectiveness differs according to cigarette addiction, socio-economic status, age or sex., Design: Correlational design using cross-sectional survey data collected monthly between 2006 and 2018., Setting: England., Participants: A total of 18 929 adults (aged ≥ 16 years, 52.0% female) who had smoked within the previous 12 months and had made at least one quit attempt during that period., Measurements: The outcome was self-reported abstinence from quit date to survey. Independent variables were self-reported use during the most recent quit attempt of: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, e-cigarettes, face-to-face behavioural support, telephone support, written self-help materials, websites and hypnotherapy. Moderators were cigarette addiction, social grade, age and sex., Findings: After adjustment for covariates and use of other cessation aids, users of e-cigarettes [odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.69-2.24] and varenicline (OR = 1.82, 95% CI = 1.51-2.21) had significantly higher odds of reporting abstinence than those who did not report use of these cessation aids. Use of prescription NRT was associated with increased abstinence in older (≥ 45 years) (OR = 1.58, 95% CI = 1.25-2.00) but not younger (< 45 years) smokers (OR = 1.09, 95% CI = 0.85-1.42). Use of websites was associated with increased abstinence in smokers from lower (OR = 2.20, 95% CI = 1.22-3.98) but not higher social grades (OR = 0.74, 95% CI = 0.40-1.38). There was little evidence of benefits of using other cessation aids., Conclusions: Use of e-cigarettes and varenicline are associated with higher abstinence rates following a quit attempt in England. Use of prescription of nicotine replacement therapy is also associated with higher abstinence rates, but only in older smokers, and use of websites only in smokers from lower socio-economic status., (© 2019 Society for the Study of Addiction.)

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.

Background: Current data on tobacco use are a necessary prerequisite for the study of the implementation of tobacco control measures in the general population. The German Study on Tobacco Use (Deutsche Befragung zum Rauchverhalten, DEBRA) provides previously lacking data on key indicators of smoking behavior and on the consumption of new products such as e-cigarettes. The continual acquisition and accumulation of data permits the analysis of trends and precise statistical evaluation., Methods: Data were obtained by repeated face-to-face interviews, at 2-month intervals, of representative samples of approximately 2000 persons across Germany aged 14 years and above. For this article, data from 12 273 persons that were acquired in 6 waves of the survey (June/July 2016 to April/May 2017) were aggregated and weighted., Results: The one-year prevalence of current tobacco consumption was 28.3% (95% confidence interval: [27.5; 29.1]) in the overall survey population and 11.9% [8.9; 14.9] among persons under age 18. Higher tobacco consumption was correlated with lower educational attainment and lower income. 28.1% of the smokers had tried to quit smoking in the past year; the most commonly used method of quitting was e-cigarettes (9.1%). Brief physician advice or pharmacotherapy for smoking cessation were tried by 6.1% and 7.0%, respectively. 1.9% of the overall survey population but only 0.3% of persons who had never smoked were current consumers of e-cigarettes., Conclusion: Tobacco consumption is very high in Germany compared to other countries in Western and Northern Europe, and its distribution across the population is markedly uneven, with a heavy influence of socioeconomic status.

The use of electronic cigarettes (e-cigarettes) among adults in the Netherlands is increasing but is still relatively low. Increasing numbers of young people abroad are experimenting with e-cigarettes but no trend data for the Netherlands are available to date. Young people who experiment with e-cigarettes are principally those young people who already smoke conventional cigarettes or have done so in the past; the same applies to adults. There are no indications that experimenting with e-cigarettes can lead to tobacco addiction. Although the vapour from e-cigarettes contains substances that are harmful to health, the health risks from the use of e-cigarettes are far smaller than those from smoking conventional cigarettes. Too few research data are available to be able to conclude that e-cigarettes are an effective aid to smoking cessation.

Background and Aims: Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomized controlled trials have suggested that e-cigarettes can aid smoking cessation, but there are many factors that could influence their real-world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought over-the-counter and with unaided quitting in the general population., Design and Setting: A large cross-sectional survey of a representative sample of the English population., Participants: The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n = 464), NRT bought over-the-counter only (n = 1922) or no aid in their most recent quit attempt (n = 3477)., Measurements: The primary outcome was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence., Findings: E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter [odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.70-2.93, 20.0 versus 10.1%] or no aid (OR = 1.38, 95% CI = 1.08-1.76, 20.0 versus 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% CI = 1.17-2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% CI = 1.19-2.18) times higher compared with those using no aid., Conclusions: Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence., (© 2014 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)