Medizinische Fakultät Recent trends in the use of tobacco ... · 6/30/2017 · • Tobacco...

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Medizinische Fakultät

Recent trends in the use of tobacco ande-cigarettes in Germany: findings from the new

DEBRA survey

Prof. Dr. Daniel Kotz30 June 2017

Heinrich-Heine-University Düsseldorf, Institute of General Practice,Centre for Addiction Research and Clinical Epidemiology

Maastricht University | University College London | University of Edinburgh

www.daniel-kotz.de


DisclosuresIndustry funding to the investigator in the last 5 yearsNone

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Tobacco-related mortality

• Tobacco smoking causes ~6 million deathsworldwide each year, including more than600,000 non-smokers who die from second-hand tobacco smoke [WHO, 2011]

• Smokers lose on average 10 life-years, andspend much of their life in lower quality andpoorer health [Doll, BMJ 2004]


Smoking in Germany

• Germany ranks among the top 10 countriesworldwide in largest number of smokers[Reitsma, Lancet 2017]

• 110,000 people die from smoking each year,including 3,300 non-smokers [Mons, Gesundheitswesen2011]

• Annual direct costs of tobacco smoking ~€8.7billion, indirect costs ~€25.9 billion [Adams, DKFZ2009]

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UK (#1)

Germany (#33)


DEBRA general aims

Provide data helping to guide tobacco controlpolicy, clinical practice and scientific research• Collect data on patterns and trends of smoking

and quitting in the German population• Assess processes of smoking and quitting and the

role played by triggers such as motivation orphysician advice, sociodemographic factors, andaids to cessation

• Assess the use of e-cigarettes and their impacton tobacco smoking and quitting

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DEBRA strengths• In-depth data on key indicators of smoking and quitting• Baseline and 6-month follow-up data

– face-to-face household interview (CAPI)– telephone follow-up interview (CATI)àcross-sectional AND longitudinal data analyses

• Bi-monthly data collection via omnibus survey, 3 years– monitoring of trends (including new innovations)

• Large accumulated data set (18 waves)– high statistical power

• Methods closely aligned to "Smoking Toolkit Study"– international comparison with England


DEBRA methods

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DEBRA sampling

• Multi-topic omnibus survey by market researchinstitute Kantar Health

• Multi-stage, multi-stratified randomprobability sampling of German population 14+

• Bi-monthly representative sample N≈2,000– 500-600 smokers > ~10,000 smokers in total


DEBRA current state

• Wave 1 = start of DEBRA: June 2016• Current analysis:

– 5 wavesJune + August + November 2016January + March 2017

– total N = 10,226 (N = 2,811 current smokers)

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DEBRA today's aims

• Recent trends in use of tobacco and e-cigarettes in Germany

• Population's support for tobacco policymeasures


Tobacco use"Which of the following best applies to you?"

• I smoke cigarettes every day > current smoker• I smoke cigarettes, but not every day• I do not smoke cigarettes at all, but I do

smoke tobacco of some kind(e.g., pipe or cigar)

• I have stopped smoking completely > ex-smokerin the last year

• I stopped smoking completelymore than a year ago

• I have never smoked > never smoker(i.e., smoked for a year or more)

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Smoking status

28.1%16.9%

55.0%

0%10%20%30%40%50%60%70%80%90%

100%

Aggregated (Jun '16 - Mar '17)

CurrentExNever

(27.3-29.9%)

(16.1-17.6%)

(54.0-56.0%)England: 17.3%

[www.smokinginengland.info]


Smoker by sex

32.7%23.8%

0%10%20%30%40%50%60%70%80%90%

100%

Males Females

Current

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Smoker by age categories

12.5%

35.8% 36.9% 33.7%

12.9%

0%10%20%30%40%50%60%70%80%90%

100%

14-17 18-20 21-34 35-64 65+

Current


Smoker by education

36.7%32.5% 32.1% 24.1%

20.2%

0%10%20%30%40%50%60%70%80%90%

100%

No qualification Junior high school(Hauptschule)

Seconday school(Realschule)

Advance tech.college

(Fachhochschule)

High school(Hochschule)

Current**

** p<0.01 for linear-by-linear trend

Level of education

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Smoker by income

36.3%30.2% 28.9% 25.4% 24.8% 23.2%

0%10%20%30%40%50%60%70%80%90%

100%

< €1,000 €1,000< €2,000

€2,000< €3,000

€3,000< €4,000

€4,000< €5,000

> €5,000

Current***

*** p<0.001 for linear-by-linear trend

Net income of the household


Use of e-cigarettes

"Have you ever used an electronic cigarette(e-cigarette) or similar product (e.g., e-shisha,e-cigar, e-pipe)"?• Yes, I still use them at current > current user• Yes, I used them regularly, > ex-user

but currently not any more• Yes, I tried them in the past, > ever tried

but currently not any more• No, I never used them > never user

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Use of e-cigarettes

1.9% 1.2%6.7%

89.7%

0%10%20%30%40%50%60%70%80%90%

100%

Aggregated (Jun '16 - Mar '17)

CurrentExEverNever

(1.7-2.2%) (1.0-1.4%)(6.2-7.2%)

(89.1-90.3%)


Use of e-cigs: trend

0%

1%

2%

3%

4%

5%

6%

7%

8%

Jun '16 Aug '16 Nov '16 Jan '17 Mar '17

CurrentExEver

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Use of e-cigarettes by age categories

2.7%

4.1% 3.9%

1.9%

0.2%0.3%

2.7% 2.9%1.1% 0.2%

10.8%13.1%

10.8%

7.2%

1.3%

0%

2%

4%

6%

8%

10%

12%

14%

14-17 18-20 21-34 35-64 65+

CurrentExEver


Smoking status within e-cig status

0%

10%20%30%

40%50%60%70%

80%90%

100%

Current Ex Ever Never

NeverExCurrent

Tobacco

E-cigs

Perc

enta

gew

ithin

e-ci

gare

ttest

atus

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Nicotine content of e-cigs[subset of current users, N=179]

41.7%

29.3%

8.1%

17.7%

2.4%

Solely with nicotineMainly with nicotineMainly without nicotineSolely without nicotineDon't know if nicotine


Reasons for e-cig use – top 10[subset of current users, N=179]

Reason % (multiple choice)1. Different flavours 35.5

2. Less expensive than tobacco 33.1

3. To smoke less tobacco without quitting 31.24. Less harmful than tobacco 30.75. It's fun 29.8

6. Less annoying for others than tobacco smoke 26.8

7. To quit tobacco 25.48 For use at places where tobacco is prohibited 24.2

9. Tastes better than smoking tobacco 22.2

10. Reduces urges to smoke tobacco 18.1

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Use of e-cigs as quit aid[subset smokers who attempted to quit, N=719]

5.5%

1.7%

0.6%

2.6%

3.7%

0.6% 0.6%

5.1%6.1%

0%1%2%3%4%5%6%7%8%9%

10%

Physicianadvice

Behaviouralsupport

Telephonesupport

NRT Rx NRT OTC Bupropion Vareniclin E-cig withnicotine

E-cig withoutnicotine

(multiple answers allowed)England:Any evidence-

based treatment~50%

[Kotz, Addiction2009]

E-cigs~35%

[www.smokinginengland.info]


DEBRA today's aims

• Recent trends in use of tobacco and e-cigarettes in Germany

• Population's support for tobacco policymeasures

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Support tobacco policy measures

Statements [Wave 2, September 2016, N=2,087]:1. The sale of cigarettes and tobacco in Germany should be

banned completely within the next 10 years2. The legal age of sale of cigarettes and tobacco in Germany

should be raised from 18 to 213. Tobacco industry sales should be taxed in order to use the

money to address problems caused by tobacco (e.g.health issues, environmental problems, etc.)

4. It should be assessed whether e-cigarettes are safe andeffective in assisting smokers to quit

5. When children are in the car, smoking inside the carshould be banned and subjected to punishment



Response categories:1. Strongly support 1+2 > agree2. Tend to support3. No opinion either way4. Tend to oppose 4+5 disagree5. Strongly oppose6. Not applicable/No answer

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22.9%

43.1%

57.1% 55.4%

71.4%

48.8%

32.1%

19.4% 17.9%10.9%

0%10%20%30%40%50%60%70%80%90%

100%

1: total banon sales

2: raiseage > 21

3: taxingindustry

4: assesse-cigs

5: banin cars

Agree Disagree Undecided No answer


Agreement by smoking status

22.9%

43.1%

57.1% 55.4%

71.4%

9.9%

34.6% 36.7%

50.1%

67.0%

23.0%

39.8%

61.3% 56.9%

71.3%

29.3%

48.4%

66.2% 57.7%

73.8%

0%10%20%30%40%50%60%70%80%90%

100%

1: total banon sales

2: raiseage > 21

3: taxingindustry

4: assesse-cigs

5: banin cars

Average Smoker Ex-smoker Never smoker

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Conclusions: tobacco

• Prevalence of tobacco smoking in Germany isrelatively high– 28% of the population smokes tobacco, incl.– 13% of children aged 14-17 years

• Social gradient in smoking tobacco:the lower the education and income thehigher the prevalence of smoking

• Only very few smokers attempting to quit useevidence-based treatments


Conclusions: e-cigarettes

• 1.9% of the population currently uses e-cigs, incl.– 2.7% of children aged 14-17 years

• E-cigs are mainly used by tobacco smokers• E-cigs are a relatively frequently used aid to

reduce and quit tobacco

à There is scientific need and public support forresearch into the effectiveness and safety of e-cigarettes as an aid to quitting

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Medizinische Fakultät Recent trends in the use of tobacco ... · 6/30/2017 · • Tobacco...

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