Waterpipe use and associated consumer characteristics in the German population: Data from a national representative survey (DEBRA study)

Abstract

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.

Keywords: German Study on Tobacco Use; Migration; Shisha; Smoking; Tobacco; Waterpipe.