Smokers' perception of the comparative health risks of cigarettes, e-cigarettes and heated tobacco products: a survey among the German population.

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.

Mental Health Symptoms and Associations with Tobacco Smoking, Dependence, Motivation, and Attempts to Quit: Findings from a Population Survey in Germany (DEBRA Study).

INTRODUCTION: This study aimed to estimate prevalence rates of mental health symptoms (anxiety, depression, and overall psychological distress) by tobacco smoking status, and associations between such symptoms and the level of dependence, motivation, and attempts to quit smoking in the German population. METHODS: Cross-sectional analysis of data from six waves of a nationally representative household survey collected in 2018/19 (N = 11,937 respondents aged ≥18). Mental health symptoms were assessed with the Patient Health Questionnaire-4. Associations with smoking status, dependence, motivation to quit, and ≥1 past-year quit attempt (yes/no) were analysed with adjusted regression models among the total group, and among subgroups of current (n = 3,248) and past-year smokers (quit ≤12 months ago, n = 3,357). RESULTS: Weighted prevalence rates of mental health symptoms among current, former, and never smokers were: 4.1%, 2.4%, 2.5% (anxiety), 5.4%, 4.7%, 4.0% (depression), and 3.1%, 2.5%, 2.4% (psychological distress). Current versus never smokers were more likely to report symptoms of anxiety and depression. Smokers with higher versus lower levels of dependence were more likely to report higher levels of all three mental health symptoms. Higher versus lower levels of overall psychological distress were associated with a higher motivation to quit smoking and, among past-year smokers, with higher odds of reporting a past-year quit attempt. CONCLUSIONS: We found various relevant associations between mental health symptoms and smoking behaviour. Healthcare professionals need to be informed about these associations and trained to effectively support this vulnerable group in translating their motivation into abstinence.

Do people know that cigarette filters are mainly composed of synthetic material? A representative survey of the German population (the DEBRA study).

INTRODUCTION: Most cigarettes are smoked with filters made of synthetic plastic, which are not fully biodegradable. Littering used cigarette filters (butts) represents a substantial environmental hazard. It is unclear if people, in particular smokers, know that filters consist of synthetic plastic. METHODS: We used data collected in August/September 2019 from a representative household survey of the German population aged 14 years and over (wave 20 of the German Study on Tobacco Use; DEBRA). Respondents were asked: 'The majority of smokers use cigarettes with a filter. What do you think these filters are composed of? (1) Mainly of natural material; (2) Mainly of synthetic material; (3) I don't know what cigarette filters are composed of.' Response option 2 indicated correct knowledge. RESULTS: A total of 2066 people were interviewed, including 625 current smokers. The weighted response rate to option 2 ('mainly of synthetic material') was 34.8% (95%CI 32.7 to 36.9) in the total sample and 42.7% (95%CI=38.7 to 46.8) in the subgroup of current smokers. In the latter subgroup, smokers with low compared with those with high educational level were less likely to know that filters are mainly composed of synthetic material (OR=0.62, 95%CI=0.39 to 0.99). CONCLUSIONS: The majority of smokers in Germany does not know that cigarette filters are mainly composed of synthetic material. Our findings suggest a need for promoting awareness as well as knowledge of environmental health hazards of cigarette filters to the general population, and specifically to current smokers. TRIAL REGISTRATION NUMBER: DRKS00011322 and DRKS00017157.

Electronic Cigarettes to Vaporize Cannabis: Prevalence of Use and Associated Factors among Current Electronic Cigarette Users in Germany (DEBRA Study).

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.

Effectiveness of training general practitioners to improve the implementation of brief stop-smoking advice in German primary care: study protocol of a pragmatic, 2-arm cluster randomised controlled trial (the ABCII trial).

BACKGROUND: The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the "5A" or the much briefer "ABC" method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. METHODS: A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. DISCUSSION: If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00012786); registered on 22th August 2017, prior to the first patient in.

From Qualitative Meta-Summary to Qualitative Meta-Synthesis: Introducing a New Situation-Specific Theory of Barriers and Facilitators for Self-Care in Patients With Heart Failure.

Situation-specific theories provide nurses with a vehicle to interpret situations, guide their decisions or make assumptions about factors influencing a health problem. In this article, we used meta-synthesis techniques to integrate statements of findings pertaining to barriers and facilitators to heart failure self-care that were derived previously through meta-summary techniques leading to a new situation-specific theory. According to our proposed theory, self-care behavior is the result of a patient's naturalistic decision-making process. This process is influenced by two key concepts: "self-efficacy" and the "patient's disease concept of heart failure." Numerous facilitative and inhibitive factors have been identified influencing these two key concepts as well as the decision-making process, thereby either enabling or hampering the execution of effective heart failure self-care. Further research is needed to validate the model through empirical testing. Once fully matured, the model may be useful in developing behavioral interventions aiming at enhancing adherence to self-care recommendations.

[Should advertising for electronic cigarettes and heated tobacco products be banned in Germany? Results of a representative survey (DEBRA study)]. / Sollte Werbung für elektrische Zigaretten und Tabakerhitzer in Deutschland verboten werden? Ergebnisse einer repräsentativen Befragung (DEBRA-Studie).

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 e­cigarettes 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 e­cigarettes and heated tobacco products.

[E-cigarettes and heat-not-burn products: representative data on consumer behaviour and associated factors in the German population (the DEBRA study)]. / E-Zigaretten und Tabakerhitzer: repräsentative Daten zu Konsumverhalten und assoziierten Faktoren in der deutschen Bevölkerung (die DEBRA-Studie).

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.

Study protocol of the German Study on Tobacco Use (DEBRA): a national household survey of smoking behaviour and cessation.

BACKGROUND: The prevalence of tobacco smoking in Germany is high (~27%). Monitoring of national patterns of smoking behaviour and data on the "real-world" effectiveness of cessation methods are needed to inform policies and develop campaigns aimed at reducing tobacco-related harm. In England, the Smoking Toolkit Study (STS) has been tracking such indicators since 2006, resulting in the adaptation of tobacco control policies. However, findings cannot be directly transferred into the German health policy context. The German Study on Tobacco Use (DEBRA: "Deutsche Befragung zum Rauchverhalten") aims to provide such nationally representative data. METHODS/DESIGN: In June 2016, the study started collecting data from computer-assisted, face-to-face household interviews in people aged 14 years and older. Over a period of 3 years, a total of ~36,000 respondents will complete the survey with a new sample of ~2000 respondents every 2 months (=18 waves). This sample will report data on demographics and the use of tobacco and electronic (e-)cigarettes. Per wave, about 500-600 people are expected to be current or recent ex-smokers (<12 months since quitting). This sample will answer detailed questions about smoking behaviour, quit attempts, exposure to health professionals' advice on quitting, and use of cessation aids. Six-month follow-up data will be collected by telephone. DISCUSSION: The DEBRA study will be an important source of data for tobacco control policies, health strategies, and future research. The methodology is closely aligned to the STS, which will allow comparisons with data from England, a country with one of the lowest smoking prevalence rates in Europe (18%). TRIAL REGISTRATION: This study has been registered at the German Clinical Trials Register ( DRKS00011322 ) on 25th November 2016.

The Relevance of Postoperative Cognitive Decline in Daily Living: Results of a 1-Year Follow-up.

OBJECTIVES: Postoperative cognitive decline (POCD) has a perceivable influence on daily living and is noticed more often by close relatives than by patients themselves 3 months after aortic valve replacement. This study aimed to elucidate the longitudinal course of the subjective awareness of POCD. DESIGN: Follow-up of a prospective observational study. SETTING: A single cardiothoracic center in Germany. PARTICIPANTS: The study included 108 patients scheduled for elective aortic valve replacement surgery and 85 close relatives of the patients. INTERVENTIONS: In addition to conducting a neuropsychologic examination, the authors previously interviewed 82 patients with a Cognitive Failure Questionnaire for self-assessment (s-CFQ), and 62 relatives with the Cognitive Failure Questionnaire for others (f-CFQ) before and 3 months after surgery. Up until 12 months after surgery, the authors continuously interviewed additional patients (baseline and 3 months after surgery), thereby enlarging the original sample, and included the entire group (108 patients, 85 relatives) for the 12-month follow-up. RESULTS: The analysis showed that relatives (p = 0.026) and patients experienced patients' cognitive decline 3 months after surgery (p = 0.009). All changes still were observed in questions related to memory and attention. After 1 year, the s-CFQ no longer differed between baseline and postoperative assessment. Mean scores in the f-CFQ still were above baseline, barely missing statistical significance (p = 0.051). In patients with "change to worse" in the f-CFQ at 1-year follow-up, declining cognitive results in nonverbal learning (p = 0.021) could be observed 3 months postoperatively. Only a decrease in 3-month f-CFQ correlated with a decline in specific neuropsychologic tests 3 months after surgery. CONCLUSIONS: Contrary to the authors' previous results, the impact of POCD on daily living functions also was recognized by the patients themselves. The long-term influence and the associations between subjective deficits and psychometric cognitive measures seemed to be assessed more reliably by close relatives.

Associations between body mass index and smoking behaviour: A cross-sectional study of the German adult population.

BACKGROUND: Both smoking and high body weight are risk factors for disease, hence, the association between smoking and body weight is an important health issue. Furthermore, concern about weight gain after quitting smoking is for many smokers a barrier to smoking cessation. The present study aims to explore the association between body mass index (BMI) and current tobacco smoking status in the population of Germany, and smoking and quitting behaviour amongst smokers (and recent ex-smokers =<12 months since quitting). METHODS: Cross-sectional analysis of two waves of data collected from March through June 2021 through a representative face-to-face household survey in Germany (N = 3 997 respondents aged ≥18). The associations between smoking and quitting behaviours and BMI were analysed through four regression models adjusted for socio-demographic, socio-economic, and smoking characteristics of respondents. RESULTS: Long-term ex-smokers (>= 12 months since quitting smoking) were more likely to have a higher BMI compared to never smokers (ß = 0.64, 95% confidence interval (CI) = 0.10-1.19). There was no statistically significant association between current smoking status or recent ex-smoking status and BMI (ß = -0.29,95 %CI = -0.75-0.17 and ß = -0.53, 95 %CI = -2.45-1.40). Among current smokers, no statistically significant association was found between BMI and the motivation to stop smoking (OR = 1.01, 95 %CI = 0.99-1.03). Neither number of cigarettes smoked a day nor outcome of most recent quit attempt were related to BMI (ß = 0.01, 95 %CI = -0.04-0.05 and OR = 0.41, 95 %CI = 0.05-3.05). CONCLUSION: In the German population long-term ex-smoking but not current and recent ex-smoking was associated with increased BMI. Future research should further explore the association between smoking behaviour and abdominal obesity, preferably using a more accurate measure for abdominal obesity than BMI.

Cannabis Use in Germany.

BACKGROUND: The federal government of Germany is planning to liberalize the recreational cannabis market for adults. We aimed to collect key baseline data on frequency of use, routes of administration, and co-use of cannabis and inhaled nicotine or tobacco products in the population. METHODS: Based on data from a national survey of 9644 people aged >14 years, we analyzed self-reported use of cannabis in the past 12 months and preferred route of administration (single choice: smoked with tobacco; smoked without tobacco; inhaled without tobacco; consumed with food; consumed in another form). RESULTS: The prevalence of past-year cannabis use was 4.6% (95% CI [4,2; 5,1%]), with higher rates among 14-24- (11.4%) and 25-39-year-olds (8.2%) as well as among co-users of inhaled nicotine or tobacco products, particularly waterpipe users (27.0%). Smoking cannabis with or without tobacco was the preferred route of administration, reported by 92.4% (95% CI [89,6; 94,6%]). It was most frequently reported by 14-24-year-olds and by co-users of inhaled nicotine or tobacco products. CONCLUSION: Smoking remains the predominant form of using cannabis-especially among younger users, who are at greatest risk of cannabis-related consequences. The true prevalence of cannabis use may have been underestimated in our study, however, as not all participants answered the questions on cannabis. Nevertheless, preventive and harm reduction efforts are needed to reduce the harm from using cannabis. Continuous monitoring is required to evaluate the effects of the forthcoming law changes in Germany.

Motivation to stop smoking in the German population between 2016 - 2021 and associated factors: results from a repeated cross-sectional representative population survey (German Study on Tobacco Use, DEBRA study).

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.

Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population.

OBJECTIVE: Climate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and provide advice on protective health behaviour against heat. Data is lacking on whether and what topic of GP advice people are interested in, and whether specific person characteristics are associated with such interests. DESIGN: Cross-sectional, nationwide, face-to-face household survey, conducted during winter 2022/2023. SETTING: Germany. PARTICIPANTS: Population-based sample of 4212 respondents (aged 14-96 years), selected by using multistratified random sampling (50%) combined with multiquota sampling (50%). MAIN OUTCOME MEASURE: Interest in receiving GP advice on health protection during heatwaves (yes/no), and the topic people find most important (advice on drinking behaviour, nutrition, cooling, cooling rooms, physical activity or medication management). Associations between predefined person characteristics and the likelihood of interest were estimated using adjusted logistic regressions. RESULTS: A total of 4020 respondents had GP contact and provided data on the outcome measure. Of these, 23% (95% CI=22% to 25%) expressed interest in GP advice. The likelihood of expressing interest was positively associated with being female, older age (particularly those aged 75+ years: 38% were interested), having a lower level of educational attainment, having a migration background, living in a more urban area, and living in a single-person household. It was negatively associated with increasing income. Advice on medication management received highest interest (25%). CONCLUSIONS: During winter season 2022/2023, around one quarter of the German population with GP contact-and around 40% of those aged 75+ years-was estimated to have a stated interest in receiving GP advice on protective health behaviour during heatwaves, especially on medication management. Climate change is creating new demands for healthcare provision in general practice. This study provides initial relevant information for research and practice aiming to address these demands.

The Effectiveness of E-Cigarettes for Smoking Cessation.

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.

Trends and consumption patterns in the use of e-cigarettes among adolescents and young adults in Germany (the DEBRA study).

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.

Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners' brief advice on and support with alcohol consumption in Germany: results of a population survey.

OBJECTIVE: The German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and harmful (exhibit health events) drinking patients. We aimed to estimate the implementation of this recommendation using general population data. DESIGN: Cross-sectional analysis of data (2021/2022) of a nationwide, population-based household survey. SETTING: Germany. PARTICIPANTS: Population-based sample of 2247 adult respondents who reported hazardous or harmful drinking according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; score women: 4-12 and men: 5-12). MAIN OUTCOME MEASURE: Ever receipt of 'brief GP advice on, or support with, reducing alcohol consumption'. Differences in the likelihood of ever receiving advice and/or support (yes/no) relative to respondents' sociodemographic, smoking and alcohol consumption characteristics were estimated using logistic regressions. RESULTS: Ever receipt of GP advice on/support with reducing drinking was reported among 6.3% (95% CI=5.3% to 7.4%), and the offer of support among 1.5% (95% CI=1.1% to 2.1%) of the hazardous and harmful drinking respondents. The likelihood of having ever received advice/support was positively associated with being older (OR=1.03 per year, 95% CI=1.01 to 1.04), a current or former (vs never) smoker (OR=2.36, 95% CI=1.46 to 3.80; OR=2.17, 95% CI=1.23 to 3.81) and with increasing alcohol consumption (OR=1.76 per score, 95% CI=1.59 to 1.95). One in two harmful drinking respondents (AUDIT-C score 10-12) reported appropriate advice/support. The likelihood was negatively associated with being woman (eg, OR=0.32, 95% CI=0.21 to 0.48), having a medium or high (vs low) education and with increasing household income. CONCLUSIONS: A small proportion of hazardous and harmful drinking people in Germany report having ever received GP advice on, or support with, reducing alcohol consumption. The implementation of advice/support seems to be linked to specific socio-demographic characteristics, tobacco smoking and alcohol consumption level. Health policy measures should aim to increase alcohol screening, brief intervention rates and awareness for at-risk populations in primary care. TRIAL REGISTRATION NUMBER: DRKS00011322, DRKS00017157.

Exposure to Tobacco Smoking in Vehicles, Indoor, and Outdoor Settings in Germany: Prevalence and Associated Factors.

Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in vehicles, indoor, and outdoor settings in the German population, using current data from a representative household survey. We used cross-sectional data (N = 3928 respondents aged 14-99 years) from two waves of the DEBRA survey (German Study on Tobacco Use), conducted between January and March 2020. The reported prevalence of SHS exposure during the last seven days was 19% in vehicles, 25% in indoor settings, and 43% in outdoor settings. We found that younger age and current smoking were consistently associated with higher SHS exposure. Furthermore, people with low education were more likely to be exposed to SHS in vehicles and indoor settings than people with high education. This study found that the prevalence of SHS exposure in vehicles, indoor, and outdoor settings is a relevant feature of everyday life in Germany, especially for younger people and people with lower education, leading to potentially persistent socioeconomic and tobacco-attributable inequalities in morbidity and mortality.

Attempts to quit smoking, use of smoking cessation methods, and associated characteristics among COPD patients.

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.