state of smoking and health in Germany

This page was last edited on: March 26, 2024 at 3:23 pm

smoking rate

16.9% (2022)

TOBACCO USE RATE

18.8% (2022)

TOBACCO USE AND TRENDS

In 2022, an estimated 13.6 million adults aged 15 years and over in Germany are tobacco product users. This positions Germany as the 17^th globally and the 4^th in the WHO European Region in terms of the number of tobacco users.
In 2021, 22.7% of adults (25.7% of males and 19.6% of females) aged 15-64 years old were current tobacco smokers in Germany (ESA Survey 2021).
In 2020, 23% of adults (27% men and 19% women) aged 15 years and over were current smokers.
In 2019, 20% of youth (19% of boys and 21% of girls) aged between 15 and 16 years old were current cigarette smokers.
Demand for cigarettes reduced by 54% from 88 packs per capita in 2002 to 40.2 packs per capita in 2022 while the demand for fine-cut tobacco (e.g. roll your RYO) per capita increased by 77% from 9 packs of 20gr weight in 2002 to 16 packs of 20gr weight in 2022 (Figure 1).

Germany, Cigarette and Fine Cut tobacco Consumption, (pack/capita) (Figure 1)

Figure 1: Cigarette and Fine Cut Tobacco Consumption in Germany
Source: European Union Eurobarometer Survey 2020

Nicotine Alternatives

In 2020, 12% of adults (15% men and 9% women) in Germany aged 15 years and over have used or at least tried e-cigarettes, while 6% (7% men and 3% women) had used or at least tried heated tobacco products (HTPs).
- 2% were current e-cigarettes and 1% were HTP users.
In 2020, 26% of current smokers were also daily hand-rolled cigarette (HRC) users.
- Among combustible tobacco and novel tobacco product users, 75% started using or tried using first with cigarettes, 9% with HTPs, and 1% with e-cigarettes.
In 2019, 16% of youth (20% of boys and 12% of girls) were current e-cigarette users.

Quit Attempts

In 2020, among those current smokers who attempted to quit smoking, 7% tried with Nicotine Replacement Therapies (NRTs), 5% with e-cigarettes and 1% with HTPs.

HEALTH AND ECONOMIC BURDEN FROM TOBACCO USE

In 2019, it is estimated that tobacco was the highest risk factor that drove the most death and disability combined in Germany.
Tobacco was responsible for an estimated 148,650 deaths (about a quarter (26%) of total deaths.
- Of tobacco deaths, 144 thousand, or 97% were due to smoking and 8 thousand or 5.4% from secondhand smoke.
In 2019, the top 10 causes of the most deaths in Germany included Ischemic Heart Disease (IHD) ranking 1st, Stroke ranking 2^nd, Lung Cancer ranking 3rd, and COPD ranking 5^th.
- Tobacco was responsible for 29 thousand or 17% of all IHD deaths, 8 thousand or 13% of all Stroke deaths, 39 thousand or 85% of all Lung Cancer deaths, and 22 thousand or 77% of all COPD deaths in Germany.
In 2019, tobacco use caused an estimated loss of 3.7 million disability-adjusted life years (DALYs)- which was about 29% of total DALYs where tobacco accounts for 188 thousand DALYs for Stroke, 806 thousand DALYs for Lung Cancer, 568 thousand DALYs for COPD, and 591 thousand DALYs for IHD.

REGULATORY ENVIRONMENT and Economics

Public Health Commitment

Germany ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2004, and the WHO Illicit Trade Protocol in 2017.
Implemented graphical health warnings (GHWs) on combustible cigarettes (CCs) in 2016..

Diverse Tobacco Market

Heated Tobacco Products HTPs and e-cigarettes with or without nicotine are available in Germany and classified as tobacco products. Key points include:
- Product restrictions for e-cigarettes include a maximum nicotine concentration of 20mg/ml, a tank capacity not exceeding 2ml, and refill containers limited to a maximum of 10ml.
- Text health warnings are mandatory for HTPs and e-cigarettes with nicotine covering 30% of both inner and outer surface packaging.

Taxation Policy

In 2023, the total tax rate on retail prices of a pack of cigarettes in Germany was 69.3%. Germany applies excise on HTPs aligning with the pipe tobacco tax plus 80% of the difference between the tax on cigarettes and the pipe tobacco [2] Meanwhile e-cigarette liquid, regardless of nicotine content, is taxed at €0.16/ml in 2023 and will progressively increase over the years till 2026.
In 2023, Germany, by the definition of tax application, applied a differential excise tax policy between CCs and HTPs. The excise value of HTP is €3.06/pack with its share (45.01%) of the retail selling price (€6.80/pack) in 2023. The excise value of CCs is €4.58/pack with the excise share (57.22%) of the retail price (€8.00/pack).

Smoking and Advertising Bans

Germany enforces minimum smoking bans with unknown compliance and slightly less than comprehensive advertising bans with moderate compliance on CCs in 2022. HTPs and e-cigarettes irrespective of nicotine content are subject to the same smoking and advertising bans as tobacco products. The federal government restricts smoking ban only on federal premises and in public places, whereas States set other smoking bans. Advertising bans are at the national level where States can impose additional regulations.

Age Restrictions

Tobacco products, e-cigs(with or without nicotine content) and HTPs cannot be sold to individuals younger than 18 years of age.

Illicit Cigarette Trade

In 2020, Germany was the second largest market for illicit trade among the EU member states where an estimated 200 million illicit cigarettes were consumed.
- Estimated figures indicate that illicit cigarette trade has been consistently increasing between 2008 and 2022 but has been remained relatively under control, fluctuating slightly above or below 8% over the years. It started at 6.7% in 2008 and reached 9.5% in 2022

As research findings become available that are inclusive of additional gender identities, the Foundation will update the information presented.

[1] Source: World Health Organization: Non-age-standardized estimates of current tobacco use, tobacco smoking and cigarette smoking (Tobacco control: Monitor) and The World Bank’s Population Estimates and Projections.

Explanation: This estimate is calculated by applying the WHO’s estimated percentage of tobacco smokers for 2023 to the World Bank’s projected population figures of the same year for 15 years and older. These figures should be used with caution, as they do not account for the 95% credible interval around the estimate.