Trends in waterpipe and e-cigarette use among young people in the European Union, 2012–2023: a repeated cross-sectional study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Alternative tobacco and nicotine-containing products can challenge progress in tobacco control. Waterpipes and e-cigarettes gained popularity among youth at different times, driven by flavours, social influence, and perceived reduced harm. This study examined trends in waterpipe and e-cigarette use among youth in the European Union (EU) from 2012 to 2023.
Methods
We analysed data from five waves (2012–2023) of the Special Eurobarometer surveys in 26 EU Member States (N = 20,466; ages 15–30). Multilevel Poisson models assessed trends by sociodemographic subgroups, adjusting for country-level factors. Adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) are reported.
Findings
From 2012 to 2023, ever waterpipe use fell from 31.2% (95% CI: 29.1–33.3%) to 14.9% (13.2–16.8%), and current use (since 2017) from 2.5% (1.8–3.5%) to 1.8% (1.2–2.7%). Ever e-cigarette use rose from 12.2% (10.8–13.8%) to 25.8% (23.7–28.2%), and current use from 1.6% (1.1–2.3%) to 5.3% (4.0–6.8%), with cross-country variation. Compared with 2017, ever waterpipe use was lower in 2023 (aPR: 0.52, 95%CI: 0.42–0.66). Ever e-cigarette use was lower in 2012 (0.47; 0.40–0.54) and 2014 (0.75; 0.67–0.84). Current waterpipe use increased in 2020 (1.96; 1.16–3.28) then declined, while current e-cigarette use rose in 2020 (1.64; 1.15–2.34) and 2023 (4.27; 2.73–6.67). By 2023, ever waterpipe use was lower across all subgroups despite earlier heterogeneity, whereas ever e-cigarette use was higher among women (1.41; 1.18–1.69), urban residents (1.27; 1.11–1.46), and those without financial difficulties (1.38; 1.20–1.60). Current e-cigarette use was also higher across all groups.
Interpretation
Declining waterpipe use and rising e-cigarette use among young Europeans show divergent patterns and differences across sociodemographic groups, particularly among women and socioeconomically disadvantaged groups. Continued surveillance and targeted interventions are needed to address emerging vulnerabilities in high-risk populations.
Funding
European Union’s Horizon 2020.
Alternative tobacco and nicotine-containing products can challenge progress in tobacco control. Waterpipes and e-cigarettes gained popularity among youth at different times, driven by flavours, social influence, and perceived reduced harm. This study examined trends in waterpipe and e-cigarette use among youth in the European Union (EU) from 2012 to 2023.
Methods
We analysed data from five waves (2012–2023) of the Special Eurobarometer surveys in 26 EU Member States (N = 20,466; ages 15–30). Multilevel Poisson models assessed trends by sociodemographic subgroups, adjusting for country-level factors. Adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) are reported.
Findings
From 2012 to 2023, ever waterpipe use fell from 31.2% (95% CI: 29.1–33.3%) to 14.9% (13.2–16.8%), and current use (since 2017) from 2.5% (1.8–3.5%) to 1.8% (1.2–2.7%). Ever e-cigarette use rose from 12.2% (10.8–13.8%) to 25.8% (23.7–28.2%), and current use from 1.6% (1.1–2.3%) to 5.3% (4.0–6.8%), with cross-country variation. Compared with 2017, ever waterpipe use was lower in 2023 (aPR: 0.52, 95%CI: 0.42–0.66). Ever e-cigarette use was lower in 2012 (0.47; 0.40–0.54) and 2014 (0.75; 0.67–0.84). Current waterpipe use increased in 2020 (1.96; 1.16–3.28) then declined, while current e-cigarette use rose in 2020 (1.64; 1.15–2.34) and 2023 (4.27; 2.73–6.67). By 2023, ever waterpipe use was lower across all subgroups despite earlier heterogeneity, whereas ever e-cigarette use was higher among women (1.41; 1.18–1.69), urban residents (1.27; 1.11–1.46), and those without financial difficulties (1.38; 1.20–1.60). Current e-cigarette use was also higher across all groups.
Interpretation
Declining waterpipe use and rising e-cigarette use among young Europeans show divergent patterns and differences across sociodemographic groups, particularly among women and socioeconomically disadvantaged groups. Continued surveillance and targeted interventions are needed to address emerging vulnerabilities in high-risk populations.
Funding
European Union’s Horizon 2020.
Date Issued
2026-10-01
Date Acceptance
2026-07-29
Citation
The Lancet Regional Health. Europe, 2026, 69
ISSN
2666-7762
Publisher
Elsevier
Journal / Book Title
The Lancet Regional Health. Europe
Volume
69
Copyright Statement
© 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Subjects
Waterpipe
E-cigarette
Prevalence
Youth
Trends
European Union
Publication Status
Published
Article Number
101815
Date Publish Online
2026-08-13