CONFERENCE PROCEEDING
Trends in ever and current use of waterpipe and e-cigarette among young people in the European Union (2012-2023): Analysis of five waves of eurobarometer surveys
1
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
2
Secretariat of Public Health, Department of Health, Generalitat de Catalunya, Barcelona, Spain
3
Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center on Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
4
CIBER en Enfermedades Respiratorias (CIBERES), Madrid, Spain
5
National and Kapodistrian University of Athens, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, Athens, Greece
Tob. Prev. Cessation 2026;12(Supplement 1):A84
ABSTRACT
BACKGROUND-AIM:
Progress in tobacco control is threatened by the rising uptake of alternative tobacco- and nicotine-containing products. Waterpipe and e-cigarettes have been popular alternatives to cigarettes among young people at different time points, driven by appealing flavours, media influence, and misperceptions of their harmlessness. This study aimed to assess trends in the prevalence of waterpipe and e-cigarette ever and current use among young people (aged 15-30 years) in the European Union between 2012 and 2023.
METHODS:
Data from five waves of the Special Eurobarometer surveys (2012, 2014, 2017, 2020, 2023) conducted in 26 Member States (excluding Croatia and the United Kingdom) were analysed (N=20,503; aged 15-30 years). Weighted prevalence estimates were calculated for ever and current use (defined as at least monthly) of waterpipe and e-cigarettes. Multilevel Poisson regression models assessed temporal trends across sociodemographic subgroups, adjusted for country-level variables (per capita actual individual consumption and tobacco control policy implementation, measured using the Tobacco Control Scale). Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported.
RESULTS:
Between 2012 and 2023, ever waterpipe use declined from 31.1% to 14.9%, and current use from 2.5% to 1.8%. Ever e-cigarette use increased from 12.2% to 25.9%, and current use from 1.6% to 5.3% with variation across Member States. Compared with 2017, ever waterpipe use decreased significantly in 2023 (APR=0.52, 95% CI: 0.41-0.65), while ever e-cigarette use was lower in earlier waves (2012: APR=0.48, 95% CI: 0.41-0.55; 2014: APR=0.72, 95% CI: 0.65-0.81). Current waterpipe use increased in 2020 compared with 2017 (APR= 1.95, 95% CI: 1.31-2.89) but decreased again by 2023. In contrast, current e-cigarette use increased both in 2020 (APR= 1.58, 95% CI:1.08-2.29) and 2023 (APR= 4.13, 95% CI: 2.59-6.59) relative to 2017. Declines in waterpipe use were greater among males and urban residents, whereas e-cigarette use rose among females, urban residents, and those with financial difficulties.
CONCLUSIONS:
Between 2012 and 2023, waterpipe use among young Europeans declined, while e-cigarette use increased, showing divergent trajectories for these two products and distinct sociodemographic drivers of experimentation and sustained use. These findings highlight the need for continued surveillance to monitor evolving patterns and emerging vulnerabilities in high-risk subgroups.
Progress in tobacco control is threatened by the rising uptake of alternative tobacco- and nicotine-containing products. Waterpipe and e-cigarettes have been popular alternatives to cigarettes among young people at different time points, driven by appealing flavours, media influence, and misperceptions of their harmlessness. This study aimed to assess trends in the prevalence of waterpipe and e-cigarette ever and current use among young people (aged 15-30 years) in the European Union between 2012 and 2023.
METHODS:
Data from five waves of the Special Eurobarometer surveys (2012, 2014, 2017, 2020, 2023) conducted in 26 Member States (excluding Croatia and the United Kingdom) were analysed (N=20,503; aged 15-30 years). Weighted prevalence estimates were calculated for ever and current use (defined as at least monthly) of waterpipe and e-cigarettes. Multilevel Poisson regression models assessed temporal trends across sociodemographic subgroups, adjusted for country-level variables (per capita actual individual consumption and tobacco control policy implementation, measured using the Tobacco Control Scale). Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported.
RESULTS:
Between 2012 and 2023, ever waterpipe use declined from 31.1% to 14.9%, and current use from 2.5% to 1.8%. Ever e-cigarette use increased from 12.2% to 25.9%, and current use from 1.6% to 5.3% with variation across Member States. Compared with 2017, ever waterpipe use decreased significantly in 2023 (APR=0.52, 95% CI: 0.41-0.65), while ever e-cigarette use was lower in earlier waves (2012: APR=0.48, 95% CI: 0.41-0.55; 2014: APR=0.72, 95% CI: 0.65-0.81). Current waterpipe use increased in 2020 compared with 2017 (APR= 1.95, 95% CI: 1.31-2.89) but decreased again by 2023. In contrast, current e-cigarette use increased both in 2020 (APR= 1.58, 95% CI:1.08-2.29) and 2023 (APR= 4.13, 95% CI: 2.59-6.59) relative to 2017. Declines in waterpipe use were greater among males and urban residents, whereas e-cigarette use rose among females, urban residents, and those with financial difficulties.
CONCLUSIONS:
Between 2012 and 2023, waterpipe use among young Europeans declined, while e-cigarette use increased, showing divergent trajectories for these two products and distinct sociodemographic drivers of experimentation and sustained use. These findings highlight the need for continued surveillance to monitor evolving patterns and emerging vulnerabilities in high-risk subgroups.
| eISSN: | 2459-3087 |
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