Evidence map›Paper›PMID 40973069›Full record

ArticleNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco2025

Waterpipe and Co-Use of Inhaled Nicotine and Tobacco Products: Findings from a Population-Based Cross-Sectional Household Survey in Germany.

Stephanie Klosterhalfen, Neal D Freedman, Daniel Kotz

Abstract read
In one paragraph

Article in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Stephanie KlosterhalfenInstitute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
Neal D FreedmanDivision of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, United States.ORCID 0000-0003-0074-1098
Daniel KotzInstitute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.ORCID 0000-0002-9454-023X

Funding

German Federal Ministry of HealthMinistry of Innovation, Science and Research of the German State of North Rhine-Westphalia (MIWF)
6 · The paper itself

Abstract

introductionThis study aims to provide prevalence data on dual-use (one additional product) and poly-use (two or more products) of inhaled nicotine and tobacco products (cigarettes, e-cigarettes and/or heated tobacco products (HTP)) among current waterpipe (WP) users in Germany over recent years, and explores specific person characteristics associated with such co-use.

methodsA series of cross-sectional, nationwide, representative, face-to-face household surveys in Germany between 2019 and 2023. Samples were selected using multistratified random sampling (50%) combined with quota sampling (50%). The current analysis included 61 713 respondents (aged ≥14 years) of which 1303 reported current WP use.

resultsWP use in Germany fluctuated between 1.5% and 2.8% from 2019 and 2023. The prevalence rate for 2023 was 1.5% (95%CI = 1.2,1.7). Among users, exclusive WP use declined from 41.8% (95%CI = 35.3,48.5) in 2019 to 26.3% (95%CI = 20.2,33.3) in 2023. Over this period, dual-use increased from 49.3% (95%CI = 42.6,56.1) to 62.3% (95%CI = 55.0,69.3), and poly-use rose from 8.9% (95%CI = 5.5,13.4) to 11.2% (95%CI = 7.1,16.7). Multivariable analyses confirmed a significant decline in exclusive WP use over time (OR per year = 0.90, 95%CI = 0.81-0.99), while the increases in dual-use was not statistically robust after adjustment. Among dual users, the majority (94.2%) reported also smoking cigarettes. The likelihood of using at least one additional product alongside WP was positively associated with increasing age, and with low and middle compared with high educational attainment.

conclusionAmong current WP users in Germany, exclusive WP use has decreased in recent years, with potential commensurate increase in dual- and poly-use. IMPLICATION: These novel data help inform on the consumption behavior of current WP users and highlights the need for targeted public health interventions that address not only exclusive product use but also the rising combination of different products.

Indexed as

NicotineTobacco ProductsVapingWater Pipe SmokingAdministration, InhalationAdolescentAdultCross-Sectional StudiesElectronic Nicotine Delivery SystemsFemaleGermanyHumansMaleMiddle AgedPrevalenceSurveys and QuestionnairesNicotine

Identifiers

PMID40973069
PMCPMC12723216

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.