Preferred Sources of Health-Risk Information About Cigarettes, e-Cigarettes, and Waterpipes Among Adolescents in Germany: A Cross-Sectional Analysis of a Large School-Based Survey.

Abstract

Background: Adolescent nicotine use remains a major public health concern, particularly in the context of increasing e-cigarette uptake and gaps in tobacco-control communication. Effective prevention requires evidence on the information channels through which adolescents prefer to receive risk information about tobacco and nicotine products.

Objectives: This study examined adolescents' preferred sources for receiving information about the health risks of cigarettes, e-cigarettes, and waterpipes in Germany, and assessed differences by age, gender, school type, and nicotine-use status.

Design: Cross-sectional analysis of a large nationwide school-based survey across 14 of 16 German federal states.

Methods: Data were drawn from the 2024/2025 wave of the Präventionsradar study and included 21,841 adolescents aged 9-17 years from 116 schools and 1,712 classes across 14 German federal states. Weighted descriptive analyses and multilevel logistic regression models were used to examine preferred information sources and information refusal. Models were adjusted for age, gender, school type, and current nicotine-product use, with random intercepts at the class level.

Results: Parents (30.2%), social media (21.5%), and physicians (18.6%) were the most frequently selected information sources. Younger adolescents more often selected parents, whereas older adolescents more often selected social media and peers. Adolescents currently using at least one tobacco or nicotine product were more likely to select friends and less likely to select parents, teachers, or physicians. They were also more likely to report not wanting health information. Information refusal was additionally associated with male gender and lower academic track.

Conclusion: Adolescents' preferred sources of tobacco- and nicotine-related health information differ substantially by sociodemographic characteristics and nicotine-use status. These findings may inform the development of differentiated and multimodal communication strategies.