Smoking is one of the most important risk factors associated with the development of chronic non-communicable diseases, especially cancer, cardiovascular and respiratory diseases and diabetes (GBD Tobacco Collaborators, 2017). The risk of tobacco-associated illnesses increases significantly when smokers start at a young age, as younger people are particularly susceptible to damage from the harmful substances contained in tobacco smoke (US Department of Health and Human Services, 2012). In addition, studies show that people who start smoking early demonstrate a greater level of dependence on tobacco and this makes it more difficult to stop smoking later in life (García-Rodríguez et al., 2014).
- Around 7 out of 100 girls and boys at age 11 to 17 years smoke.
- Smoking prevalence in children and adolescents has decreased significantly over time.
- The proportion of children and adolescents that smokes increase with age.
By education group
In 2015, 7.2% of children and adolescents aged 11 to 17 years smoke (girls: 7.4%, boys: 7.0%). In contrast, three times as many children and adolescents (21.6%) smoked in 2004. In terms of age, smoking prevalence is significantly higher among 14- to 17-year-olds at 11.5% than among 11- to 13-year-olds at 0.7%. This age-specific pattern is evident among both sexes. In 2015, no pronounced differences in smoking behaviour among children and adolescents were observed by region or parental education.
Although smoking prevalence in late childhood and adolescence has decreased over time, in 2015, one in every fourteen 11- to 17-year-olds in Germany smoked (Zeiher et al., 2018). There is no noticeable association between the prevalence of smoking and parental education. However, significant differences in smoking behaviour by the type of secondary school the respondents attended were identified and the prevalence was highest among children attending schools not geared towards university entry qualifications (Kuntz and Lampert, 2013). Therefore, measures to prevent children and adolescents from smoking, as set out in the “reducing tobacco consumption” national health goal (BMG, 2015), remain an important aspect of diabetes prevention. These measures also need to consider newer forms of nicotine consumption such as e-cigarettes and (e-)shishas.
Show more information on methodology and data sources
The indicator of smoking is defined as the proportion of children and adolescents in the population who smoke daily or occasionally.
Information on smoking behaviour was collected as self-reported data provided by children and adolescents aged between 11 and 17 years.
Children and adolescents with permanent residence in Germany, aged 11-17 years.
Nationwide RKI interview and examination surveys 2003-2006 (KiGGS baseline study), 2009 to 2012 (KiGGS Wave 1) and 2014-2017 (KiGGS Wave 2) based on a registry office sample with data collected using self-administered questionnaires.
Number of cases
- KiGGS baseline study: n = 17,641, of which 6,729 aged between 11 and 17 years
- KiGGS Wave 1 (cross-sectional survey): 12,368, of which 4,944 aged between 11 and 17 years
- KiGGS Wave 2 (cross-sectional survey): 15,023, of which 4,747 aged between 11 and 17 years
- Description: For the indicator, the figures for total, girls and boys are provided and stratified by age group, residential area and parental education as far as the number of cases available for the figure is ≥5 and the statistical uncertainty in the estimate of the indicator is not considered too large (a coefficient variation ≤ 33.5%).
- Stratification: The geographical classification of the residence of the participating person was carried out by region (north-east, north-west, middle-east, middle-west and south). Educational status of the parents was determined using the CASMIN index, which takes information on both school and vocational training into account and allows a categorisation into a low, medium and high education group.
- Weighting: In order to correct for deviations from the underlying reference population due to different participation rates or sampling probabilities, weighting factors were used when calculating the indicator. These adjust the surveys to the population structure of the reference population with regard to sex, age, federal state, German citizenship (yes/no) and parental education as at 31 December 2015.
The RKI surveys for children and adolescents provide representative results for the 0 to 17-year-old resident population in Germany. Various measures (including oversampling of children and adolescents without German citizenship), enabled migrants to be included in the KiGGS sample approximately in line with their proportion of the population. Nevertheless, further efforts are necessary in the future, especially for children and adolescents with little knowledge of German.