Consumer preference and perception of specific categories of tobacco and related products.
Date: 2021-05-19
Institutions: Directorate-General for Health and Food Safety
Subjects: EU Member State, United Kingdom, directive (EU), economic consequence, health policy, report, sampling, smoking, social impact, tobacco, tobacco industry

Consumer preference and 
perception of specific categories 
of tobacco and related products 

Request for Service Chafea/2017/Health/34 under 
Framework Contract Chafea/2015/CP/01 

Specific contract number 2017 85 07 

By Francisco Lupiáñez-Villanueva, George Gaskell, Ines Lecland, Alena Sokolyanskaya, 
Simone Vitiello Alexandra Theben, Olena Tigova, Angel Esteve Fernandez-Muñoz 

August 2020 

Third 
EU Health 
Programme 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EUROPEAN COMMISSION 

Directorate-General for Health and Food Safety 

Directorate C — Public health, country knowledge, crisis management 

Unit C4 — Health determinants and international relations 

E-mail: sante-consult-c4@ec.europa.eu 

European Commission  

L-2920 Luxembourg 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
Consumer preference and 
perception of specific categories 
of tobacco and related products 

Request for Service Chafea/2017/Health/34 under 
Framework Contract Chafea/2015/CP/01 

Specific contract number 2017 85 07 

 
 
 
 
 
 
 
 
 
 
Consumer  preference  and  perception  of  specific  categories  of  tobacco  and  related 
products 

DG SANTE 

Acknowledgements 

We would like to thank John Britton and Armando Peruga for their valuable review of the final 
report.  We  would  also  like  to  thank  Julia  Langer,  Katja  Bromen,  Matus  Ferech  and  Marc 
Vandenbroeck for their ongoing support throughout the project.  

Disclaimer 

This report was produced in response to the Request for Services Chafea/2017/Health/34 "Study 
about Consumer preference and perception of specific categories of tobacco and related products 
under framework contract Chafea_2015 CP 01 for the provision of behavioural studies – second 
wave.  The  content  of  this  report  represents  the  views  of  the  contractor  and  is  its  sole 
responsibility; it  can  in  no  way  be  taken  to  reflect  the  views  of  the  European  Commission  or 
other body of the European Union. The European Commission does not guarantee the accuracy 
of the data included in this report, nor does it accept responsibility for any use made by third 
parties thereof.  

More information on the European Union is available on the Internet (http://www.europa.eu). 

PDF  

ISBN 978-92-76-37788-7 

doi: 10.2875/740949 

EW-05-21-126-EN-N 

Luxembourg: Publications Office of the European Union, 2021 

© European Union, 2021 

The reuse policy of European Commission documents is implemented by the Commission Decision 2011/833/EU of 12 December 2011 
on the reuse of Commission documents (OJ L 330, 14.12.2011, p. 39). Except otherwise noted, the reuse of this document is authorised 
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that reuse is allowed provided appropriate credit is given and any changes are indicated. 

 
 
 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

TABLE OF CONTENTS 

EXECUTIVE SUMMARY ................................................................................................................................................ 7 

1 

INTRODUCTION ................................................................................................................................................ 14 
1.1 
BACKGROUND ................................................................................................................................................. 14 
1.2  OBJECTIVES AND SCOPE ................................................................................................................................ 17 
1.3  OVERALL APPROACH ....................................................................................................................................... 19 
Systematic review and gap analysis......................................................................................... 21 
1.3.1 
1.3.2 
Focus groups...................................................................................................................................... 24 
1.3.3  Online survey .................................................................................................................................... 25 
RATIONALE OF THE REPORT ........................................................................................................................... 30 

1.4 

2  WATERPIPE TOBACCO ...................................................................................................................................... 31 
2.1 
BACKGROUND ................................................................................................................................................. 31 
2.2  MARKET DEVELOPMENTS ................................................................................................................................ 35 
Socio-demographic characteristics............................................................................................ 35 
2.2.1 
2.2.2 
Pattern of use .................................................................................................................................... 39 
2.2.3  Dual use with other tobacco and related products ............................................................. 48 
CONSUMER PERCEPTION ................................................................................................................................ 52 
2.3 
2.4  HEALTH, SOCIAL AND ECONOMIC IMPACTS .................................................................................................. 61 
CONCLUDING REMARKS ON WATERPIPE TOBACCO ....................................................................................... 63 
2.5 

3 

4 

5 

SLIM CIGARETTES ............................................................................................................................................. 65 
3.1 
BACKGROUND ................................................................................................................................................. 65 
3.2  MARKET DEVELOPMENTS ................................................................................................................................ 70 
Socio-demographic characteristics............................................................................................ 70 
Pattern of use .................................................................................................................................... 74 
Parallel use with other tobacco and related products ........................................................ 83 
CONSUMER PERCEPTION ................................................................................................................................ 87 
3.3 
3.4  HEALTH, SOCIAL AND ECONOMIC IMPACTS .................................................................................................. 93 
CONCLUDING REMARKS ON SLIM CIGARETTES ............................................................................................. 95 
3.5 

3.2.1 
3.2.2 
3.2.3 

SMALL CIGARILLOS ........................................................................................................................................... 97 
BACKGROUND ................................................................................................................................................. 97 
4.1 
4.2  MARKET DEVELOPMENTS .............................................................................................................................. 100 
Socio-demographic characteristics.......................................................................................... 100 
Pattern of use .................................................................................................................................. 104 
Parallel use with other tobacco and related products ...................................................... 115 
4.3 
CONSUMER PERCEPTION .............................................................................................................................. 121 
4.4  HEALTH, SOCIAL AND ECONOMIC IMPACTS ................................................................................................ 128 
CONCLUDING REMARKS ON SMALL CIGARILLOS......................................................................................... 129 
4.5 

4.2.1 
4.2.2 
4.2.3 

NOVEL TOBACCO PRODUCTS .......................................................................................................................... 131 
BACKGROUND ............................................................................................................................................... 131 
5.1 
5.2  MARKET DEVELOPMENTS .............................................................................................................................. 135 
Socio-demographic characteristics.......................................................................................... 135 
Pattern of use .................................................................................................................................. 139 
Parallel use with other tobacco and related products ...................................................... 149 
5.3 
CONSUMER PERCEPTION .............................................................................................................................. 153 
5.4  HEALTH, SOCIAL AND ECONOMIC IMPACTS ................................................................................................ 169 

5.2.1 
5.2.2 
5.2.3 

5 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

5.5 

CONCLUDING REMARKS ON NOVEL TOBACCO PRODUCTS .......................................................................... 172 

ELECTRONIC CIGARETTES ............................................................................................................................... 174 
6.1 
BACKGROUND ............................................................................................................................................... 174 
6.2  MARKET DEVELOPMENTS .............................................................................................................................. 184 
Socio-demographic characteristics.......................................................................................... 184 
Pattern of use .................................................................................................................................. 188 
Parallel use with other tobacco and related products ...................................................... 200 
6.3 
CONSUMER PERCEPTION .............................................................................................................................. 207 
6.4  HEALTH, SOCIAL AND ECONOMIC IMPACTS ................................................................................................ 219 
CONCLUDING REMARKS ON ELECTRONIC CIGARETTES .............................................................................. 221 
6.5 

6.2.1 
6.2.2 
6.2.3 

COMPARATIVE ANALYSIS OF TOBACCO AND RELATED PRODUCTS ................................................................. 224 
7.1  MARKET DEVELOPMENTS .............................................................................................................................. 224 
7.2 
CONSUMER PERCEPTION .............................................................................................................................. 230 
7.3  HEALTH, SOCIAL AND ECONOMIC IMPACTS ................................................................................................ 232 

CONCLUSION .................................................................................................................................................. 238 

REFERENCES ................................................................................................................................................... 243 

6 

7 

8 

9 

10 

ANNEXES .................................................................................................................................................... 251 
10.1 
BACKGROUND ........................................................................................................................................... 251 
10.2  WATERPIPE TOBACCO PRODUCTS ........................................................................................................... 257 
SLIM CIGARETTES .................................................................................................................................... 268 
10.3 
NOVEL TOBACCO PRODUCTS ................................................................................................................... 275 
10.4 
ELECTRONIC CIGARETTES........................................................................................................................ 285 
10.5 
COMPARATIVE ANALYSIS ......................................................................................................................... 289 
10.6 

11 

12 

LIST OF FIGURES ......................................................................................................................................... 294 

LIST OF TABLES ........................................................................................................................................... 301 

6 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

EXECUTIVE SUMMARY 

The European Union (EU) and Member States (MS) have implemented a number of measures to 
reduce  the  consumption  of  tobacco  and  related  products.  These  initiatives  were  designed  to 
support the functioning of the internal market and to ensure a high level of  health protection. 
The  revised  Tobacco  Products  Directive  2014/40/EC  (TPD)  acts  as  one  of  the  main  pillars  of 
tobacco control in the EU. In terms of geographic scope, the study focused on the 27 EU Member 
States and the United Kingdom (UK). Despite the UK  leaving the EU and the transition period 
ending on 31 December 2020, the UK will be considered and referred to as a Member State for 
the purposes of this report. Moreover, conditionally to the results of the ongoing negotiations, 
the TPD may continue to apply in Northern Ireland also after 2020. 

The current study is a contribution to the Commission’s report to the European Parliament and 
the Council by 20 May 2021 on the application of the Directive, as per Article 28(1) of the TPD. 
The  study  covers  five  categories  of  tobacco  and  related  products,  namely  waterpipe  tobacco, 
slim  cigarettes,  small  cigarillos,  novel  tobacco  products  and  electronic  cigarettes.  The  market 
developments,  consumer  perceptions,  and  the  health,  social  and  economic  impacts  for  each 
product were investigated. The study comprised a systematic literature review and analysis of 
existing  data  with  the  objective  of  identifying  informational  gaps.  To  investigate  these  gaps, 
focus group discussions were held in five Member States (France, Germany, Bulgaria, Spain and 
Greece)  to  collect  qualitative  insights  into  current  trends.  An  online  survey  was  designed  to 
assemble quantitative evidence about consumer perceptions and reported behaviours. To ensure 
geographical coverage the following Member States were surveyed, Bulgaria, France, Germany, 
Greece,  Italy,  Latvia, Poland, Slovakia, Spain and the UK.  In  each  country two samples were 
recruited. The first  sample was 600 smokers and people who had quit in the last 12 months, 
aged 26 and above. Prompted by concerns about the use of tobacco and related products among 
young people, the second sample was comprised of 600 people between the age of 18-25. A 
total  of  12,000  respondents  were  surveyed.  The  following  paragraphs  present  generic  and 
product specific findings from the research. 

Risk perception. Conventional cigarettes were perceived as the most harmful, about 20% less 
harmful  were  small  cigarillos  and  slim  cigarettes,  and  at  a  further  15%  less  harmful  were  e-
cigarettes, HTPs and waterpipe tobacco. Current users of e-cigarettes rated them as about 50% 
less harmful than conventional cigarettes. Users of a particular product consistently rated the 
health  risk  to  be  lower  than  the  rest  of  the  sample  but  still  rated  the  product  as  harmful  to 
health. The older age group (26 years +) reported lower risk perception of tobacco and related 
products than the younger age group.  

Quitting the use of tobacco and related products. A small percentage of current users of 
the tobacco and related products featured in this study reported quitting all tobacco products. 
Many more had tried to quit particular products, sometimes on a number of occasions, motivated 
by concerns about their health, health warning messages and worry about the health of others. 
Price was also a factor. Those who were unsuccessful attributed the failure to stress, the difficulty 
of stopping, their social environment, or concluded that what they were trying to quit was not 
that harmful or that it was less harmful than other products. Clearly, addiction makes quitting a 
painful challenge. 

Dual  use.  The  majority  of  users  of  particular  tobacco  products  were  dual  users  of  tobacco 
products with conventional cigarette smoking being most frequently cited. For example, while 
only 8% of current e-cigarette users in the 18-25 age group used no other product, 74% were 
dual users of whom 82% reported smoking conventional cigarettes. In the 26+ age group 78% 
of the current e-cigarette users reported dual use; 90% cited smoking conventional cigarettes. 

7 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Another common thread across the range of products was under age initiation in the use of 
tobacco products.  

Regulation. The majority of the survey respondents thought that the current tax regime and 
regulations on conventional tobacco products should be applied to e-cigarettes and HTPs. They 
also agreed that the current prohibitions on smoking cigarettes at work, in public transport and 
in bars and restaurants should also apply to e-cigarettes and HTPs.  

Waterpipes. In the 18-25 age group 27% had tried waterpipe tobacco, 15% were past users 
and  11%  current  users.  Spain,  Bulgaria  and  Greece  had  the  highest  percentages  of  current 
users. Use of waterpipe tobacco varied from daily to monthly with sessions between 5 and 30 
minutes.  Industry  marketing  targeted  younger  people  with  flavoured  tobacco  blends  and  in 
parallel  social  media  provided  a  new  channel  for  indirect  advertisements  via  user-generated 
content. Waterpipe use appealed to both men and women who cited the attractions of the social 
ritual, affordability, low health risk perception, and feelings of zen, pleasure, and relaxation. A 
significant  majority  in  both  age  groups  were  dual  users;  cigarettes,  e-cigarettes  and  slim 
cigarettes were popular choices. The use of waterpipes in premises such as shisha bars, where 
products  are  unpacked  by  staff,  may  limit  users’  exposure  to  health  warnings.  Compared  to 
other tobacco and related products, waterpipe tobacco is subject to variable and often lower tax 
rates across the EU, potentially distorting the internal market.  

Slim cigarettes. Since 2000, the market share for slim cigarettes has grown significantly in a 
declining EU cigarette market. Slim cigarettes with the thinner packaging were marketed as a 
high-status product with an image of feminine elegance, exclusivity and modernity. The survey 
found that about 40% of current users were male. Compared to conventional cigarettes, they 
were perceived as ‘lighter’, giving off less odour, more discrete and socially acceptable. While 
respondents acknowledged the risks to health, slim cigarettes were seen as less harmful to users 
and bystanders than  conventional cigarettes. 70%  of  slim cigarette users also  reported using 
other tobacco and related products. 

Small cigarillos. The tobacco industry has promoted small cigarillos as a luxury, up- market 
product, a  small cigar as enjoyed by successful people in business and connoisseurs.  In both 
age groups the current users reported themselves as high socio-economic status. Small cigarillos 
contribute  to  special  occasions  and  social  gatherings.  In  both  age  groups  enjoyment  and 
socialising led people to smoke cigarillos. Over 90% of current smokers reported dual use and 
of  these  90%  reporting  the  smoking  of  conventional  cigarettes.  Among  the  current  smokers 
there were twice as many men than women. In total 6% of the 18-25 age group were current 
users  with  7%  in  the  26+  age  group.  Above  average  consumption  was  found  in  the  younger 
generation in the UK, Spain and France, and in the older generation in Italy, Spain and Poland. 
Low prices in some Member States and the introduction of flavours making inhalation easier and 
more  pleasant  (some  TPD  restrictions  do  not  apply  to  small  cigarillos)  were  mentioned  as 
attractive features. 

Novel  tobacco  products.  The  current  study  focused  on  heated  tobacco  products  (HTPs)  of 
which the market-leading brand IQOS was introduced in Europe in 2017. The EU Member States 
have  adopted  different  position  on  HTPs  with  respect  to  taxes,  resulting  in  different 
interpretations  of  how  to  implement  the  TPD,  and  large  variations  in  prices  across  European 
countries. Studies funded by the tobacco industry have claimed to show significant reductions 
in  the  exposure  to  harmful  constituents  compared  to  conventional  cigarettes,  a  claim  that 
independent studies have called into question. In the focus groups there was some confusion 
between HTPs and e-cigarettes, about what was inhaled and whether they would be safer than 
other  tobacco  products.  Some  thought  that  they  might  be  less  satisfying  than  conventional 
cigarettes  and  offer  only  a  ‘cold  experience’.  In  the  18-25  age  group  8%  were  current  HTP 

8 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

smokers, 7% past users and 16% had tried HTPs once or twice. The UK, Italy and Bulgaria had 
above  average  numbers  of  current  users.  Marketing  and  promotion  of  HTPs  has  included 
alleviating health concerns through claims that HTPs are reduced-risk products; designing HTP 
systems to boost the user’s social image; using a “bait and hook” pricing strategy; employing 
social  marketing  techniques  and  brand  ambassadors;  selling  and  marketing  via  multiple 
channels, including dedicated stores, retail establishments and e-commerce websites. Younger 
respondents were twice as likely to have heard about the product through social media. In the 
older generation there were 11% current users, 6% past users and 10% had tried them. In this 
26+ age group Italy and Spain had above average numbers of current users. In both age groups 
‘enjoyment’ was mentioned by about three in ten as the reason for taking up HTPs. For the 26+ 
age group 41% cited ‘trying to quit or reduce consumption of another tobacco product’, a reason 
mentioned  by  29%  of  the  younger  age  group.  In  a  word  association  task,  the  most  frequent 
associations with HTPs for the 18-25 age group were ‘unhealthy’, ‘modern and technological’, 
and ‘costly’. The 26+ age group selected a similar list of associations – ‘unhealthy’, ‘modern and 
technological’, and ‘costly’. More than 80% of current HTP users in both age groups were dual 
users with 8 out of 10 reporting conventional cigarette use. The majority of respondents agreed 
that HTPs should be regulated as conventional cigarettes and many supported restrictions in the 
use of HTPs in workplaces, public transport and bars and restaurants.  

Electronic cigarettes. E-cigarettes have gained increased popularity in recent years. In parallel 
policy  initiatives  promoting  e-cigarettes  as  a  risk  reduction  mechanism  for  current  cigarette 
smokers versus the concern that e-cigarette use could open a gateway for young people to take 
up smoking conventional cigarettes  or develop addictive behaviours are hotly debated. In the 
two  age  groups  about  half  of  the  respondents  had  tried  e-cigarettes.  15%  of  the  18-25  age 
group were current users as were 33% in the 26+ age group. Of current users in the 18-25 age 
group 74% were dual users (82% citing cigarettes). In the 26+ age group 78% were dual users 
(90%  citing  cigarettes).  Between  the  two  age  groups  there  was  a  striking  difference  in  the 
reasons  for  using  e-cigarettes.  Marginally  more  current  users  in  the  younger  age  group  cited 
‘enjoyment’, but almost double the number in the older age group compared to the younger age 
group cited ‘to quit or reduce consumption of other tobacco products’. Of the past users of e-
cigarettes 24% in the 18-25 age group and 23% in the 26+ age group were now not using any 
tobacco or related products. However, in the younger age group 23% had progressed from e-
cigarettes to other tobacco products, mainly conventional cigarettes, as had 31% of the older 
age group, suggestive of the gateway scenario. Should both scenarios be shown to have some 
validity it will present a dilemma for public policy. 

The findings of this study highlight the need for increased and centralised efforts to monitor and 
assess  marketing  strategies  employed  by  the  tobacco  industry  (e.g.  via  internet  and  social 
media) to adequately protect the public, and young people in particular, from exposure to online 
marketing  of  novel  tobacco  products.  The  online  environment  should  be  monitored  for  sales 
control given that many e-cigarettes and e-liquids are advertised and purchased online. Various 
measures could be implemented to reduce the rate of uptake of e-cigarettes by younger people 
e.g.  plain  packaging  has  been  suggested  as  an  effective  measure  to  reduce  the  marketing 
advantages of certain products. To educate the public, exchange of best practices on MS-level 
or  EU-wide  campaigns  should  be  encouraged.  Finally,  research  is  needed  to  produce  robust 
evidence  on  the  health  impacts  of  NTPs  as  well  as  the  potential  impact  of  different  policy 
interventions.  

9 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

RÉSUMÉ ANALYTIQUE 

L’Union Européenne (UE) et les Etats membres ont mis en place un nombre de mesures pour 
réduire la consommation des produits du tabac et des produits connexes. Ces initiatives ont été 
conçues  pour  soutenir  le  fonctionnement  du  marché  intérieur  et  pour  garantir  un  niveau  de 
protection élevé en matière de santé. La Directive révisée sur les produits du tabac 2014/40/UE 
(« la Directive ») constitue l’un des piliers principaux du contrôle du tabac dans l’UE. En termes 
de périmètre géographique, l’étude portait sur les 27 Etats membres de l’UE et le Royaume-Uni. 
Malgré le retrait du Royaume-Uni de l’UE et la période de transition se terminant le 31 décembre 
2020,  le  Royaume-Uni  sera  considéré  et  mentionné  comme  Etat  membre  dans  le  cadre  du 
présent  rapport.  De  plus,  en  fonction  des  résultats  des  négociations  en  cours,  la  Directive 
pourrait continuer de s’appliquer en Irlande du Nord aussi après 2020. 

La présente étude contribue au rapport de la Commission au Parlement Européen et au Conseil 
d’ici  le  20  mai  2021  sur  l’application  de  la  Directive,  conformément  à  l’article  28(1)  de  la 
Directive. L’étude porte sur cinq catégories de produits du tabac et produits connexes, à savoir 
le tabac à pipe à eau, les cigarettes fines, les petits cigarillos, les nouveaux produits du tabac et 
les cigarettes électroniques. Les évolutions du marché, les perceptions des consommateurs, et 
les  impacts  sociaux,  économiques  et  en  matière  de  santé  de  chaque  produit  ont  été  étudiés. 
L’étude a compris un examen documentaire et une analyse des données existantes dans l’objectif 
d’identifier les lacunes en matière d’information. Pour enquêter sur ces lacunes, des groupes de 
discussions ont été conduits dans cinq Etats membres (France, Allemagne, Bulgarie, Espagne, 
Grèce) afin de recueillir des informations qualitatives sur les tendances actuelles. Une enquête 
en  ligne  a  été  réalisée  pour  rassembler  des  données  quantitatives  sur  les  perceptions  et  les 
comportements  déclarés  des  consommateurs.  Pour  garantir  la  représentation  géographique 
l’enquête  a  été  réalisée  en  Bulgarie,  France,  Allemagne,  Grèce,  Italie,  Lettonie,  Pologne, 
Slovaquie, Espagne et au Royaume-Uni. Dans chaque pays, deux échantillons ont été recrutés. 
Le premier échantillon contenait 600 fumeurs et personnes qui ont arrêté de fumer dans les 12 
derniers  mois,  âgés  de  26  ans  et  plus.  Poussé  par  les  préoccupations  concernant  la 
consommation  de  tabac  et  de  produits  connexes  chez  les  jeunes,  le  second  échantillon  était 
composé  de  600  personnes  âgées  de  18  à  25  ans.  Au  total,  12  000  personnes  ont  été 
interrogées. Les paragraphes suivants présentent les résultats généraux et spécifiques à chaque 
produit de notre recherche.  

Perception du risque. Les cigarettes classiques sont perçues comme les plus nocives, les petits 
cigarillos et les cigarettes fines environ 20 % moins nocifs, et les cigarettes électroniques, tabac 
chauffé  et tabac à pipe à eau encore 15% moins nocifs. Les utilisateurs actuels de cigarettes 
électroniques  les  perçoivent  environ  50%  moins  nocives  que  les  cigarettes  classiques.  Les 
utilisateurs  d'un  produit  particulier  ont  à  chaque  fois  estimé  que  le  risque  pour  la  santé  était 
inférieur au reste de l'échantillon, mais ils ont tout de même estimé que le produit était nocif 
pour la santé. Le groupe plus âgé (26 ans et plus) a montré une perception du risque lié aux 
produits du tabac et produits connexes plus faible que le groupe plus jeune.  

Arrêter  l’usage  des produits  du  tabac  et  produits  connexes.  Un  faible  pourcentage  des 
utilisateurs actuels des produits du tabac et produits connexes présentés dans cette étude ont 
déclaré arrêter de fumer tous les produits du tabac. Bien plus ont essayé d’arrêter des produits 
spécifiques, parfois à plusieurs reprises, motivés par des préoccupations concernant leur santé, 
les avertissements de santé et des inquiétudes concernant la santé d'autrui. Le coût était aussi 
un facteur. Ceux qui n’ont pas réussi ont attribué l’échec au stress, à la difficulté d’arrêter, à 
leur environnement social, ou ont conclu que ce qu’ils essayaient d’arrêter n’était pas si nocif ou 
était  moins  nocif  que  d’autres  produits.  Il  est  clair  que  la  dépendance  rend  l’arrêt  du  tabac 
d’autant plus difficile.   

10 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Double usage. La majorité des utilisateurs de produits particuliers du tabac sont des doubles 
utilisateurs  de  produits  du  tabac,  la  consommation  de  cigarettes  classiques  étant  la  plus 
souvent  citée.  Par  exemple,  alors  que  seulement  8%  des  fumeurs  actuels  de  cigarettes 
électroniques  dans  le  groupe  de  18-25  ans  n’utilisait  aucun  autre  produit,  74%  étaient  des 
doubles utilisateurs dont 82% ont déclaré fumer des cigarettes classiques. Dans le groupe de 26 
ans et plus, 78% des fumeurs actuels de cigarettes électroniques ont déclaré un double usage ; 
90% déclarant fumer des cigarettes classiques.  Un autre point commun à toute la gamme de 
produits était l'initiation avant l'âge à la consommation de produits du tabac.  

Réglementation. La majorité des participants à l’enquête trouvent que les réglementations et 
le  régime  fiscal  actuels  sur  les  produits  traditionnels  du  tabac  devraient  être  appliqués  aux 
cigarettes électroniques et aux produits du tabac chauffés. Ils s’accordent aussi à dire que les 
interdictions actuelles de fumer des cigarettes au travail, dans les transports publics et dans les 
bars et restaurants devraient aussi s’appliquer aux cigarettes électroniques et aux produits du 
tabac chauffés. 

Tabac à pipe à eau (« waterpipe »). Dans le groupe de 18-25 ans, 27% avaient essayé le 
tabac à pipe à eau, 15% étaient d’anciens utilisateurs et 11% des utilisateurs actuels. L’Espagne, 
la Bulgarie et la Grèce ont montré les plus hauts pourcentages d’utilisateurs actuels. L’usage du 
tabac à pipe à eau variait de quotidien à mensuel avec des sessions entre 5 et 30 minutes. Le 
marketing de l’industrie a ciblé les jeunes avec des mélanges de tabacs aromatisés et en parallèle 
les réseaux sociaux ont fourni un nouveau vecteur de publicités indirectes via le contenu généré 
par les utilisateurs. Le tabac à pipe à eau attire autant les hommes que les femmes qui ont cité 
l’attrait du rituel social, l’accessibilité financière, la perception d’un risque faible pour la santé, 
et la sensation de zen, plaisir, et relaxation. Une grande majorité des deux groupes d’âges sont 
des  doubles  utilisateurs ;  les  cigarettes,  cigarettes  électroniques  et  cigarettes  fines  sont  les 
principaux choix. L’usage du tabac à pipe à eau dans des lieux tels que les bars à chicha, où les 
produits  sont  déballés  par  le  personnel,  peut  limiter  l’exposition  des  utilisateurs  aux 
avertissements de santé. Comparé aux autres produits du tabac et produits connexes, le tabac 
à pipe à eau est soumis à des taux d’imposition variables et souvent inférieurs à travers l’UE, 
susceptibles de distordre le marché intérieur.  

Cigarettes  fines  (« slim »).  Depuis  2000,  la  part  de  marché  des  cigarettes  fines  a 
considérablement augmenté dans un marché européen des cigarettes en déclin. Les cigarettes 
fines avec leur emballage plus fin ont été commercialisées comme un produit de prestige avec 
une image d'élégance féminine, d'exclusivité et de modernité. L’enquête a montré que environ 
40% des utilisateurs actuels étaient des hommes. Comparées aux cigarettes traditionnelles, elles 
sont  perçues  comme  « plus  légères »,  produisant  une  odeur  moins  forte,  plus  discrètes  et 
acceptables socialement. Bien que les participants reconnaissent les risques pour la santé, les 
cigarettes fines sont considérées comme moins nocives pour les fumeurs et les personnes qui 
se  trouvent  autour  que  les  cigarettes  classiques.  70%  des  utilisateurs  de  cigarettes  fines  ont 
déclaré aussi utiliser d’autres produits du tabac et produits connexes.  

Petits cigarillos. L’industrie du tabac a mis en avant les petits cigarillos comme un produit de 
luxe, haut de gamme, un petit cigare apprécié par les hommes et femmes d'affaires prospères 
et les connaisseurs. Dans les deux groupes d’âge les utilisateurs actuels se sont déclarés comme 
venant  d’un  milieu  socio-économique  élevé.  Les  petits  cigarillos  contribuent  à  des  occasions 
spéciales  et  à  des  rassemblements  sociaux.  Dans  les  deux  groupes  d’âge,  le  plaisir  et  la 
socialisation ont amené les gens à fumer des cigarillos. Plus de 90% des fumeurs actuels ont 
déclaré un double usage et parmi eux 90% ont déclaré fumer des cigarettes classiques. Il y avait 
deux fois plus d’hommes que de femmes parmi les fumeurs actuels. Au total 6% du groupe de 
18-25  ans  étaient  des  utilisateurs  actuels  et  7%  dans  le  groupe  de  26  ans  et  plus.  Une 

11 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

consommation au-dessus de la moyenne a été trouvée dans la population jeune du Royaume-
Uni, de l’Espagne, de la France, et dans la population plus âgée en Italie, Espagne et Pologne. 
Les  prix  bas  dans  certains  Etats  members  et  l’introduction  d’arômes  rendant  l’inhalation  plus 
facile  et  plus  agréable  (certaines  restrictions  de  la  Directive  ne  s’appliquent  pas  aux  petits 
cigarillos) ont été mentionnés comme des caractéristiques attrayantes. 

Nouveaux  produits  du  tabac.  La  présente  étude  porte  sur  les  produits  du  tabac  chauffés 
(« heated tobacco products » ou HTP), dont la marque IQOS, leader du marché, a été introduite 
en Europe en 2017. Les Etats membres de l’UE ont adopté des positions différentes sur les HTP 
en termes de taxes, menant à différentes interprétations sur comment appliquer la Directive, et 
à de grandes variations de prix entre pays européens. Des études financées par l’industrie du 
tabac ont prétendu montrer des réductions significatives de l'exposition aux composants nocifs 
par rapport aux cigarettes classiques, une affirmation que des études indépendantes ont remise 
en question. Dans les groupes de discussion, il y a eu une certaine confusion entre les HTP et 
les cigarettes électroniques, sur ce qui était inhalé et si les HTPs seraient plus sûrs que les autres 
produits du tabac. Certains ont pensé qu’ils pouvaient être moins satisfaisants que les cigarettes 
classiques  et  offrir  une  moindre  expérience.  Dans  le  groupe  des  18-25  ans  8%  étaient  des 
fumeurs actuels de HTP, 7% d’anciens utilisateurs et 16% avaient essayé des HTP une ou deux 
fois. Le Royaume-Uni, l’Italie et la Bulgarie avaient des nombres d’utilisateurs actuels supérieurs 
à la moyenne. La commercialisation et la promotion des HTP ont entre autres visé à atténué les 
préoccupations de santé en affirmant que les HTP sont des produits à risque réduit ; à concevoir 
des systèmes de HTP pour renforcer l'image sociale de l'utilisateur ; à utiliser une stratégie de 
tarification  "appât  et  hameçon"  ;  à  employer  des  techniques  de  marketing  social  et  des 
ambassadeurs de marque ; à vendre et à commercialiser via de multiples canaux, notamment 
des magasins spécialisés, des établissements de vente au détail et des sites web de e-commerce. 
Les plus jeunes participants avaient deux fois plus de chance d’avoir entendu parler du produit 
par les réseaux sociaux. Dans la génération plus âgée, 11% étaient des utilisateurs actuels, 6% 
d’anciens utilisateurs et 10% en avaient essayé. Dans ce groupe de 26 ans et plus, l’Italie et 
l’Espagne  avaient  des  nombres  d’utilisateurs  actuels  supérieurs  à  la  moyenne.  Dans  les  deux 
groupes d’âge, le « plaisir » a été mentionné par environ trois personnes sur dix comme étant 
la raison de l'adoption des HTP. Pour le groupe de 26 ans et plus, 41% ont cité « essayer d’arrêter 
ou de réduire sa consommation d’un autre produit du tabac », une raison mentionnée par 29% 
du  plus  jeune  groupe  d’âge.  Lors  d’un  exercice  d’association  des  mots,  les  plus  fréquentes 
associations avec les HTP pour les 18-25 ans étaient « mauvais pour la santé », « moderne et 
technologique »,  et  « coûteux ».  Le  groupe  de  26  ans  et  plus  a  choisi  une  liste  similaire 
d’associations – « mauvais pour la santé », « moderne et technologique », et « coûteux ». Plus 
de  80%  des  utilisateurs  actuels  de  HTP  dans  les  deux  groupes  d’âge  étaient  des  doubles 
utilisateurs avec 8 personnes sur 10 déclarant utiliser des cigarettes classiques. La majorité des 
répondants s’est accordée à dire que les HTP devraient être réglementés comme les cigarettes 
classiques et beaucoup se sont montrés en faveur de restrictions dans l’usage des HTP dans les 
lieux de travail, les transports publics et les bars et restaurants.   

Cigarettes électroniques. Les cigarettes électroniques ont gagné en popularité ces dernières 
années. En parallèle, les initiatives politiques visant à promouvoir les cigarettes  électroniques 
en tant que mécanisme de  réduction des  risques pour les fumeurs de cigarettes actuels et la 
crainte  que  l'utilisation  des  cigarettes  électroniques  n'ouvre  aux  jeunes  la  possibilité  de 
commencer  à  fumer  des  cigarettes  classiques  ou  de  développer  des  comportements  de 
dépendance font l'objet d'un débat animé. Dans les deux groupes d’âge environ la moitié des 
répondants avaient essayé la cigarette électronique. 15% des 18-25 ans étaient des utilisateurs 
actuels ainsi que 33% des 26 ans et plus. Parmi les utilisateurs actuels dans les 18-25 ans 74% 
étaient des doubles utilisateurs (82% citant la cigarette). Dans les 26 ans et plus 78% étaient 

12 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

des  doubles  utilisateurs  (90%  citant  la  cigarette).  Entre  les  deux  groupes  d’âge  on  note  une 
différence frappante dans les raisons d’utiliser les cigarettes électroniques. Marginalement plus 
d’utilisateurs actuels dans le plus jeune groupe d’âge ont cité « le plaisir », alors que presque le 
double de personnes dans le groupe plus âgé comparé au plus jeune groupe ont cité « arrêter 
ou  réduire  la  consommation  d’un  autre  produit  du  tabac ».  Parmi  les  anciens  utilisateurs  de 
cigarettes  électroniques  24%  des  18-25  ans  et  23%  des  26  ans  n’étaient  plus  utilisateurs 
d’aucun produit du tabac ou de produits connexes actuellement. Cependant, dans le plus jeune 
groupe 23% ont évolué des cigarettes électroniques vers d’autres produits du tabac, surtout les 
cigarettes  classiques,  tout  comme  31%  du  groupe  plus  âgé,  suggérant  un  scénario  de  porte 
d’entrée.  Si  les  deux  scénarios  devaient  s'avérer  valables,  cela  posera  un  dilemme  pour  les 
politiques publiques. 

Les conclusions de cette étude soulignent la nécessité d'accroître et de centraliser les efforts de 
suivi et d'évaluation des stratégies de marketing employées par l'industrie du tabac (par exemple 
via internet et les réseaux sociaux) pour protéger de manière adéquate le public, et les jeunes 
en particulier, contre l'exposition à la commercialisation en ligne de nouveaux produits du tabac. 
L'environnement en ligne devrait être surveillé pour le contrôle des ventes étant donné que de 
nombreuses  cigarettes  et  liquides  électroniques  sont  vendus  et  achetés  en  ligne.  Diverses 
mesures  pourraient  être  mises  en  œuvre  pour  réduire  le  taux  d'adoption  des  cigarettes 
électroniques par les jeunes, par exemple, l'emballage neutre a été suggéré comme une mesure 
efficace pour réduire les avantages commerciaux de certains produits. Pour éduquer le public, il 
convient d'encourager l'échange de bonnes pratiques sur les campagnes menées au niveau des 
États membres ou de l'UE. Enfin, plus de recherche est nécessaire pour produire des preuves 
solides sur les effets des nouveaux produits du tabac sur la santé ainsi que sur l'impact potentiel 
des différentes interventions politiques. 

13 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

1 

Introduction 

1.1  Background  

Tobacco  consumption  is  the  single largest  avoidable  health  risk  and  is  accountable  for  nearly 
700,000 deaths each year in the European Union (EU) alone (EC, 2020). In fact, compared to 
the rest of the world, the World Health Organisation (WHO) reported that the European region 
had one of the highest proportions of deaths attributable to tobacco (Glahn et al., 2018).  The 
consumption of tobacco and related products puts both consumers and passive (or second-hand) 
users  at  higher  risks  of  developing  health  problems,  such  of  cancer,  cardiovascular  and 
respiratory  diseases.  Consumption  by  younger  generations  has  also  been  particularly 
concerning,  as  93%  of  consumers  reported  taking  up  the  product  use  before  they  turned  26 
years (EC, 2020). 

Tobacco control efforts have been advancing worldwide, and the EU and its Member States (MS) 
have implemented a number of legal, political and financial measures to reduce the consumption 
of tobacco and related products. The aim of these initiatives was to facilitate the functioning of 
the internal market while protecting public health. Specifically, in terms of consumer protection, 
they sought to protect the general public from the harmful effects of tobacco consumption, as 
well as to assist current users to quit, and to discourage others – notably younger generations 
–  from  taking  up  tobacco  use.  The  EU  has  implemented  a  number  of  tobacco  legislations1, 
including the Tobacco Products Directive (2014/40/EU) (TPD). This entered into force on 
19 May 2014 to replace the 2001 Directive (2001/37/EC) and became applicable in EU Member 
States (MS) on 20 May 2016.2  

The TPD has been the backbone of regulation around the manufacturing, presentation and sale 
of tobacco products in the EU. It was developed in response to the emergence of new scientific 
evidence  around  effective  control  measures,  new  tobacco  and  related  products  entering  the 
market, as well as the EU’s ratification of the WHO’s Framework Convention on Tobacco Control 
(WHO FCTC) in 2005. It lays down rules governing the manufacture, presentation and sale of 
tobacco and related products. Some of the key provisions of the Directive include, but are not 
limited to, requirements around packaging and labelling, reporting tobacco product ingredients, 
prohibiting characterising flavours in cigarettes and roll-your-own tobacco, banning promotional 
and  misleading  elements  on  tobacco  products,  and  tracking  and  tracing  measures  to  combat 
illicit trade. Exemptions from the rules were authorised for some products but warranted a close 
monitoring of the market developments. These exemptions must be removed if a ‘substantial 
change of circumstances’3 is detected on the market, as per Art. 2(28) of the TPD. The TPD thus 
effectively aimed to maximise health protection and consumer awareness among EU citizens. In 
this context, objective and up-to-date market data on recent market trends, product perceptions 
and uptake of products by young people are essential for the operationalisation of the Directive.  

Partly owing to these measures, there has been considerable progress in consumer protection 
related to tobacco and related products in the EU. The Eurobarometer 458 revealed an overall 

1 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32003L0033 
https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32010L0013 
https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELLAR:220cd0f2-82d0-4734-8a7f-e0dff6c8fc5d  
2 https://ec.europa.eu/health/sites/health/files/tobacco/docs/dir200137ec_tobaccoproducts_en.pdf 
33 A substantial change of circumstances is defined as an increase of at least 10 % in at least five Member States, based 
on sales data or an increase of the level of prevalence of use in the under 25 years of age consumer group by at least 
five  percentage  points  in  at  least  five  Member  States  for  the  respective  product  category  (based  on  the  Special 
Eurobarometer 385 report of May 2012) or equivalent prevalence studies. 

14 

 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

increase in the awareness of negative impacts of conventional cigarettes, as well as a  parallel 
decrease in the use of tobacco products in the EU between 2012 and 2017. Decreases have been 
seen in 20 of the 28 countries considered, while it increased or remained stable in 7.4 However, 
the last few years have seen the introduction to the EU market and the rise in popularity of new 
tobacco and related products (Regan, 2012), with products such as the electronic cigarettes (e-
cigarettes) and heated tobacco products (HTPs). The EU has closely monitored the developments 
of  the  market  to  adequately  tackle  current  and  upcoming  challenges  and  to  ensure  that 
regulations  adequately  respond  to  the  market  developments.  For  instance,  e-cigarettes  have 
recently come under intense public scrutiny following a series of e-cigarette-related deaths and 
lung injuries in the United States (USA) in summer of 2019. While the phenomenon appeared to 
be unique to the USA, renewed research and policy discussions have been triggered on the safety 
of these products and their regulatory provisions.  

In  the  TPD  five  product  categories  were  identified  for  close  monitoring  in  the  EU:  waterpipe 
tobacco, slim cigarettes, small cigarillos, electronic cigarettes, and novel tobacco products. The 
latter products were broadly defined to encompass new developments in the tobacco market. 
Recently, heated tobacco products have emerged on the market and the present report focusses 
on this product to address issues and developments linked to novel tobacco products. Table 1 
provides  an  overview  of  the  consumption  rates  of  these  five  product  categories  across  EU 
Member  States  and  reflects  the  range  of  “national  consumption  ecologies”  according  to  2017 
data, where data was available. The highest share of consumers of waterpipe tobacco was found 
in Austria (4%), followed by Latvia (3%). The countries with the largest share of slim cigarettes 
consumers  were  Bulgaria  (9%),  Lithuania  (7%)  and  Latvia  (7%).  For  small  cigarillos,  France 
(2%) and Belgium (2%) were the most relevant markets across EU Member States. Among the 
countries  for  which  data  was  available  on  electronic  cigarettes,  the  countries  with  the  largest 
share of users were the UK (5%), France (4%) and Belgium (4%).  

4 Source: Eurobarometer 458. EU average for 2012 and 2015 was calculated for 27 EU members. No data were 
available for Croatia prior to 2017 and therefore a trend could not be implied. 

15 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Table 1. Current Consumption by product and by Member State 

Smokers5  Novel  tobacco 

products6  

Small 
cigarillos7 

Slim 
cigarettes8 

Electronic 
cigarettes9 

Water  pipe 
tobacco10 

Average 
starting 
age11 

EU28 

AT 

BE 

BG 

CZ 

DK 

DE 

EE 

IE 

EL 

ES 

FR 

HR 

IT 

CY 

LV 

LT 

LU 

HU 

MT 

NL 

PL 

PT 

RO 

SI 

SK 

FI 

SE 

UK 

26% 

28% 

19% 

36% 

29% 

19% 

25% 

23% 

19% 

37% 

28% 

36% 

35% 

24% 

28% 

32% 

29% 

21% 

27% 

24% 

19% 

30% 

26% 

28% 

28% 

26% 

20% 

7% 

17% 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

1.04% 

1.96% 

2.09% 

0.36% 

1.16% 

1.33% 

1.50% 

0.69% 

0.00% 

0.37% 

0.56% 

2.16% 

0.35% 

0.48% 

1.40% 

0.32% 

0.29% 

0.84% 

0.27% 

1.20% 

1.14% 

0.60% 

0.52% 

- 

0.28% 

0.26% 

1.60% 

0.42% 

0.51% 

1.03% 

1.80% 

0.68% 

9.33% 

2.90% 

0.16% 

0.37% 

2.96% 

0.26% 

1.71% 

0.23% 

0.24% 

1.91% 

1.75% 

1.68% 

6.62% 

7.16% 

1.07% 

0.80% 

0.43% 

0.12% 

4.32% 

0.48% 

1.56% 

2.17% 

1.91% 

0.17% 

- 

0.38% 

2% 

3% 

4% 

- 

1% 

2% 

2% 

1% 

2% 

3% 

1% 

4% 

- 

- 

3% 

1% 

1% 

2% 

1% 

2% 

2% 

1% 

1% 

- 

1% 

- 

1% 

- 

5% 

1% 

4% 

2% 

1% 

1% 

1% 

1% 

1% 

0% 

0% 

0% 

0% 

0% 

1% 

2% 

3% 

1% 

2% 

1% 

0% 

0% 

1% 

0% 

0% 

1% 

1% 

0% 

1% 

1% 

17.8 

17.7 

17 

18.8 

18.3 

17.1 

18.1 

18.8 

17.3 

19.1 

17.8 

17.8 

18.6 

17 

19.2 

19.7 

19.9 

18.2 

17.4 

17.1 

17.3 

18.9 

17.6 

18.9 

18.4 

17.9 

17.4 

17.2 

17.1 

Note:  Cells  in  Red  reveal  high  consumption  across  the  market  while  those  in  Green  show  low 
consumption.  
Source:  OE  elaboration  of  Eurobarometer  458  (2017)  and  WHO  data  available  at 
https://www.who.int/tobacco/publications/prod_regulation/heated-tobacco-products/en/  

5 Percentage of people currently interviewed smoking cigarettes, cigars, cigarillos or pipe. This percentage excludes e-
cigarettes and novel tobacco products (Eurobarometer 458) 
6 Countries where HTPs are marketed as of September 2017 (WHO) 
7 Percentage of people interviewed currently smoking cigarillos. OE elaboration of Eurobarometer 458 
8 Percentage of people interviewed currently smoking slim cigarettes. OE elaboration of Eurobarometer 458 
9 Percentage of people interviewed currently using electronic cigarettes. Eurobarometer 458 
10 Percentage of people interviewed currently using water pipe tobacco products. Eurobarometer 458 
11 Average starting age of people interviewed smoking cigarettes, cigars, cigarillos or pipe. This percentage excludes e-
cigarettes and novel tobacco products (Eurobarometer 458) 

16 

 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

1.2  Objectives and scope  

The  present  study  is  a  contribution  to  the  European  Commission’s  monitoring  of  the  use  of 
tobacco  and  related  products.  It  aims  to  support  the  Commission  by  assessing  how  specific 
product categories are perceived by the public, what impacts they may have, and the mapping 
of consumer preferences and use patterns of these products. The study is also relevant to the 
2021 Report on the Application of the Tobacco Products Directive 2014/40/EU (TPD), which the 
Commission will submit to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions. As previously mentioned, the five product 
categories of tobacco and related products that fall within the scope of this study are presented: 

  Waterpipe tobacco. A “tobacco product that can be consumed via a waterpipe. For the 
purpose  of this study,  and in line with the TPD, waterpipe tobacco is deemed to be a 
tobacco product for smoking. If a product can be used both via waterpipes and as roll-
your-own tobacco, it shall be deemed to be roll-your-own tobacco” [Art.2(13)]. 

  Slim  cigarette.  A  tobacco  stick  with  an  outer  wrapper  that  is  not  made  of  natural 
tobacco leaves and that can be consumed via a combustion process and has a diameter 
of less than 7.5 millimetres [Art. 28(e)].  

  Small  cigarillos.  In  line  with  references  to  in  Article  8(1)  of  Council  Directive 
2007/74/EC and Article 4(1) of Directive 2011/64/EU, cigarillos are rolls of tobacco with 
an outer wrapper of natural tobacco of a maximum weight of 3 grams each and that may 
come with or without filter. For the purpose of this study a reference is made to “small” 
cigarillos in the sense of their likeness with factory-made cigarettes (typically of a weight 
of 1 gram with a filter) [Art. 2(12)].  

  Novel  tobacco  product.  A  tobacco  product  that  "(a)  does  not  fall  into  any  of  the 
following categories: cigarettes, roll-your-own tobacco, pipe tobacco, waterpipe tobacco, 
cigars, cigarillos, chewing tobacco, nasal tobacco or tobacco for oral use; and (b) was 
placed  on  the  market  after  19  May  2014"  [Art.  2(14)].  Current  examples  include  the 
heated tobacco products (HTPs).  

  Electronic  cigarette.  A  “product  that  can  be  used  for  consumption  of  nicotine-
containing  vapour  via  a  mouthpiece,  or  any  component  of  that  product,  including  a 
cartridge, a tank and the device without cartridge or tank. Electronic cigarettes can be 
disposable or refillable by means of a refill container and a tank, or rechargeable with 
single use cartridges.” [Art. 2(16)]. E-liquid is typically distributed in cartridges or refill 
containers – the latter is a receptacle that contains a nicotine-containing liquid, which 
can be used to refill an electronic cigarette. 

The research aimed to address three general objectives: 

 

 
 

to capture the market developments concerning different tobacco and related products 
and to understand what the main drivers of these developments are;  
to determine the extent to which these changes are driven by consumer perceptions;  
to assess the health, social and economic impacts associated with these developments.  

Specifically, the market developments focussed on various key aspects for each tobacco and 
related product category at the EU level and (see Figure 1.). It aimed at better understanding 
the current landscape of the EU market of tobacco and related products and the way in which 
EU  citizens  were  using  these  products.  Consumer  perceptions  focussed  on  what  users  and 
past  users  and  never  users  think  about  the  harmfulness,  risk,  addictiveness,  regulation  and 
preferences  of the five  product categories. Given the different characteristics of  each product 
category, specific issues were analysed in greater detail. With regards to novel tobacco products, 
uptake in trends by age profile was identified as key indicator to monitor changes in the tobacco 
market.  Consumer  perception  and  branding  of slim  cigarettes  were  also  important,  especially 

17 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

with a focus on differences between genders. On e-cigarettes issues of interest included reasons 
for initiating their use, whether they have functioned as an aid to cessation of use of conventional 
cigarettes  and  whether,  for  young  people,  they  act  as  a  gateway  to  the  use  of  conventional 
cigarettes. Finally, for both waterpipe tobacco and e-cigarette users there was the question of 
the using of flavouring and how these have affected user choices. The impacts were categorised 
in three areas: health impacts, social impacts and economic impacts. The figure below sketches 
the scope of the study.  

Figure 1. Scope of the study 

Source: Own elaboration 

In terms of geographic scope, the study focused on the 27 EU Member States and the United 
Kingdom (UK). Despite the UK leaving the EU and the transition period ending on 31 December 
2020,  the  UK  will  be  considered  and  referred  to  as  a  Member  State  for  the  purposes  of  this 
report. Moreover, conditionally to the results of the ongoing negotiations, the TPD may continue 
to apply in Northern Ireland also after 2020. 12 

12 General background https://ec.europa.eu/commission/presscorner/detail/en/QANDA_20_104. Notice on the 
withdrawal of the UK and EU rules on tobacco and related products: 
https://ec.europa.eu/info/sites/info/files/brexit_files/info_site/tobacco-products_en_0.pdf 

18 

Small cigarillosSlim cigaretteElectronic cigaretteWaterpipe tobaccoNovel tobacco productsMarket developments•Demography: i.e. age, gender, education level, socio-economic status, regional distribution  •Product use: i.e. frequency, quantity, duration of use•Parallel use of other tobacco product categories•Initiation of use: i.e. age, determinants, link to the use of other product categories•Cessation: i.e. Frequency, quantity, duration of useConsumer perception•About the product: i.e. harmfulness, risk, addictiveness, preference•About the users:i.e.trendy, passive harm and risk Impacts•Health impacts: i.e. life expectancy, incidence of cancer and cardiovascular diseases, expected healthy life years, etc.•Social impacts: i.e. labour force (reduced active labour force), environment (fire risk), etc.•Economic impacts: i.e. economic burden, level standards, poverty levels, medical expenses  
 
 
 
  
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

1.3  Overall approach  

To address the objectives and scope of this study a mixed-methods approach was adopted in 
which different methods/instruments and different sources (primary and secondary data) were 
collected and subsequently triangulated. Figure 2. summarises the overall approach to the study. 

Figure 2. Overall approach 

Source: Own elaboration 

For the analysis of market developments, a variety of available data sources were drawn upon, 
including  the  Eurobarometer  458  survey  (op.  cit.),.),  market  information  from  commercial 
sources, and data  submitted by the tobacco industry as part  of regulatory requirements.  The 
analysis  was  further  enriched  by  the  results  of  a  systematic  literature  review.  In  terms  of 
monitoring changes in market and consumer perceptions, the challenge was that (i) the market 
penetration of the products within scope was low (seldom more than 2%), that (ii) there was 
relatively  little  extant  research  on  them,  and  (iii)  existing  data  pointed  to  national/cultural 
differences  in  preferences  across  the  different  product  categories.  The  two  primary  data 
collection  methods,  focus  groups  and  an  online  survey,  were  designed  to  complement  the 
existing sources and, in particular, to focus on the gaps identified in the literature. Information 
on the social, health and economic impacts drew mainly on secondary sources. 

19 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 2 maps the research areas of the study against the different methodologies used.  

Table 2. Mixed methods approach 

Research questions 

Market developments 

•  Demography: i.e. age, gender, education level, socio- 

economic status, regional distribution  

•  Product use: i.e. frequency, quantity, duration of use  

•  Parallel use of other tobacco product categories 

• 

Initiation of use: i.e. age, determinants, link to the use 
of other product categories  

•  Cessation: i.e. frequency, quantity, duration of use  

Consumers perceptions 

•  Product perception 

•  Potential appeal and harm to youth 

•  Risk and harm to active and passive users 

Impacts 

•  Health  impacts:  i.e.  life  expectancy,  incidence  of 

cancer, expected healthy life years, diseases, etc. 

•  Social  impacts:  i.e.  social  acceptability,  exposition, 

social smoking, social disruption, etc. 

Main information 
source 

Support 
information source 

Secondary data 
gathered & online 
survey 

Literature review 

Literature review & 
focus groups 

Secondary data 
gathered & online 
survey 

Secondary data 
gathered 

Focus group & 
literature review 

•  Economic 

impacts: 

level 
standards,  poverty  levels,  medical  expenses,  labour 
force, etc. 

i.e.  economic  burden, 

Source: Own elaboration 

In  terms  of  geographic  coverage,  the  preparatory  phase  focused  on  all  EU  Member  States 
and, when necessary, relevant literature beyond the EU was also considered. A robust secondary 
data search was conducted (i.e. a literature review and quantitative information review) to define 
the  state-of-the-art  in  available  knowledge  on  the  five  products  in  scope.  It  also  looked  to 
identify the main information gaps to be addressed in primary data collection phase in order to 
effectively answer the study’s research questions. Country coverage of primary data collection 
focussed on a representative subgroup of countries based on the following criteria: 

  geographic distribution and representativeness of the countries; 
  national  tobacco  consumption  profile,  including  a  diverse  selection  of  countries  with 

high, medium and low prevalence of tobacco consumption; 

  extent  of  introduction  of  novel  products  such  as  heated  tobacco  products  into  the 

 

national market since at least September 2017; 
countries  with  particularly  high  and  low  market  penetration  of  small  cigarillos,  slim 
cigarettes, electronic cigarettes and waterpipe tobacco. 

These  consumption  characteristics  were  explored  through  the  analysis  of  secondary  data 
gathered from the 2017 Eurostat survey, Passport data and WHO data.13 With this information, 
the 2017 EU market (see Table 1) was reconstructed to aid in the selection of countries for the 
fieldwork in order to reflect the range of “national consumption ecologies”. Focus groups and an 
online survey in a representative subgroup of EU Member States were used to collect qualitative 

13 Eurobarometer 458 

20 

 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

and  quantitative  data  to  fill informational  gaps  identified  during the  preparatory  phase  of  the 
study. In the following sections, a brief description of the main methods used is provided. More 
detailed information can also be found in Technical Appendices. 

1.3.1 Systematic review and gap analysis 

An extensive literature review was conducted in order to gain an up to date and comprehensive 
picture  on  what  is  known  about  market  developments  and  consumer  perceptions  of  different 
tobacco  product  categories.  For  this  purpose,  a  total  of  685  records  were  initially  identified 
through database searching. This list was reduced to 171 items comprising both the scientific 
and  the  grey  literature  after  title  and  abstract  screening.  The  final  list  of  171  records  was 
gathered, read in detail and summarised to reconstruct the state-of-the-art on the tobacco and 
related products under scope. Of the 171 articles, 67 were from the US and Canada, 45 from 
Member  States  of  the  European  Union  and  59  from  other  countries.  Technical  Appendix  I 
provides the full methodology and protocol used to carry out the systematic review. 

As part of the literature review, different qualitative information  was collected for the  various 
products within scope. Table 3 summarises the areas where information was retrieved, and those 
where no information was found. Where the cell is striped, the information available was partial 
and  collected  via  additional  desk  research.  Exhaustive  information  was  found  for  waterpipe 
tobacco  products  and  electronic  cigarettes.  Only  partial  information  was  found  for  small 
cigarillos,  novel  tobacco  products  and  slim  cigarettes.  Further  additional  desk  research  filled 
some of the gaps, especially for small cigarillos and slim cigarettes, while only minor additional 
information was found for novel tobacco products. Some of the difficulties in discovering articles 
related to small cigarillos and slim cigarettes refer to the fact that they are often considered as 
subcategories  of  cigarettes  and  cigars,  and  as  such  they  are  more  rarely  the  focus  of  ad-hoc 
studies. As a result, no specific articles were found on the impacts of these two products.  

Table 3. Literature review information found by product  

Small 
cigarillos 

Waterpipe 
tobacco 

Electronic 
cigarettes 

Novel tobacco 
products 

Slim 
cigarette 

Market Developments 

Availability and promotion 

Patterns of use 

Consumer perceptions  

Trends & preferences 

Perceived risk & harmfulness 

Impacts  

Outcomes 

Policy implications 

Available information 

Partial information available via additional desk research 

Source: Own elaboration 

In  terms  of  novel  tobacco  products,  little  information  was  available  due  to  their  recent 
introduction in the market. Information on the patterns of use were limited to early results from 
Italy.  No  information  was  found  on  the  perceived  risk  and  harmfulness,  as  well  as  the  policy 
implications of these products. In describing HTPs, one of the major producers stated that they 

21 

 
 
 
  
 
  
  
  
  
  
  
  
  
  
  
 
  
  
  
  
  
  
  
  
  
  
 
  
  
  
  
  
  
  
  
  
  
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

were  “designed  as  an  alternative  to  cigarettes  for  current,  adult  smokers”14,  but  data  on  the 
patterns of use have not been collected as yet. Data on the consumer perception of the perceived 
risk and harmfulness of novel tobacco products were also lacking up to the date of the review. 
The data gathering activity was conducted to gain an up to date and comprehensive picture on 
the  available  data  on  market  developments  and  consumer  perceptions  of  different  tobacco 
product  categories. This research  was  carried  out using inter alia: official statistics, statistical 
portals  and  customised  Google  searches.  The  data  collected  was  mapped  following  the 
dimensions specified in the Technical Specifications.  

Table 4. Results by tobacco product category  

Tobacco product category 

Number of data sources collected 

Novel Tobacco Products 

Small cigarillos 

Slim cigarettes 

Electronic cigarettes  

Waterpipe  

Source: Own elaboration 

3 

5 

4 

4 

5 

Technical  Appendix  II  provides  a  summary  of  the  data  mapping  activity  carried  out.  Table  5 
summarises  the  areas  where  quantitative  information  was  retrieved,  and  those  where  no 
information  was  found.  In  the  striped  cells,  the  information  available  was  partial  in  terms  of 
geographic scope and quality. 

Table 5. Quantitative information found by product  

Small 
cigarillos 

Waterpipe 
tobacco 

Electronic 
cigarettes 

Novel tobacco 
products 

Slim 
cigarette 

Market Developments 

Market size 

Pricing 

Consumer population 

Initiation age 

Quit ratio and attempts 

Import-Export data 

Market Share 

Consumer perceptions  

Health perception 

Advertising impact 

Consumer perception 

Impacts  

Taxation 

Expenditure & affordability 

Third party exposure  

Health impact 

Available information 
Partial information in terms of geographic scope and quality 

Source: Own elaboration 

14 https://cot.food.gov.uk/sites/default/files/tox2017-25.pdf 

22 

 
 
 
  
 
  
  
  
  
  
  
  
  
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
  
  
  
  
  
  
  
  
 
 
 
 
 
 
  
  
  
  
  
  
  
  
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

For market developments, no data was found on the demographics of the users of novel tobacco 
products. Data on consumer perception of small cigarillos and waterpipe was extracted from the 
Global Tobacco Surveillance System (GTSS) database, while no data was found for novel tobacco 
products. Although the data gathered from the GTSS database provided a starting point for the 
analysis of consumer perceptions of these product categories, the available data was restricted 
to three EU Member States and, as such, the geographical coverage of the analysis was limited. 
With regard to the analysis  of impacts, the  study focused  on the health, economic and  social 
dimensions. In terms of economic impacts, the analysis was limited to taxes for all products due 
to the availability of data. In terms of social impacts, the data for small cigarillos and waterpipes 
was limited to the GTSS database and therefore has the above-mentioned limitations. Limited 
data was found regarding health impacts of novel tobacco products.  

Data gaps were found to be particularly significant for novel tobacco products.  However, HTPs 
had  been  introduced  in  a  few  Member  States  that  provided  an  appropriate  setting  to  collect 
information on these products. An in-depth review of the available market data also allowed us 
to identify and select countries in which the use of these products were more common.  

Table 6. Summary of the main information gaps 

Literature review gaps 

• 

• 

• 

There was very limited information about pattern of use of novel tobacco products 

There was no information about the perceived risk & harmfulness of novel tobacco products 

Information related to the socio-economic and health impacts of small cigarillos, slim cigarettes and 
novel tobacco products was limited 

Quantitative data gaps 

• 

From a geographical point of view, data for Cyprus and Luxembourg was limited 

•  Data for HTPs was limited. There was little to no data on: 

• 

• 

Social impacts of HTPs for all countries 

Initiation / cessation of HTPs 

•  Demography of population using HTPs 

•  Use of HTPs  

Source: Own elaboration 

23 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

1.3.2 Focus groups  

The focus groups were designed to provide a qualitative approach to people's knowledge of and 
attitudes towards the different tobacco and related products, and to better formulate the survey 
questions in a clear and understandable manner. The focus groups had a standard duration of 
120 minutes. They targeted consumers of tobacco and related products or those that quit in the 
last 12 months, while taking into account gender, product usage and age balance. A total of 41 
participants  aged  20  to  69  years  old  took  part  in  the  activities.  The  countries  in  which  focus 
groups  were  conducted  are  listed  in  table  7  below  and  the  rationale  for  selecting  them  is 
presented in the following paragraph. 

Table 7. Focus groups geographical scope 

Country  

Bulgaria (E) 

Germany (C) 

France (W) 

Greece (S) 

Spain (S)  

n 

9 

8 

8 

8 

8 

Age range 

24 - 69 

22 - 63 

20 – 66 

20 – 58 

20 - 57 

Source: Own elaboration 

Bulgaria was a country showing high consumption of tobacco and the highest consumption of 
slim cigarettes across the EU. Germany showed high rates of small cigarillos consumption and 
had a significant waterpipe tobacco market, according to Passport data. France was also found 
to be a very relevant market since it showed an overall high consumption of tobacco products, 
and specifically of small cigarillos and electronic cigarettes. Greece was also the country with the 
highest  percentage  of  tobacco  consumers,  and  Spain  was  flagged  by  the  Catalan  Institute  of 
Oncology (Institut Català d'Oncologia, ICO) experts due to its early adoption of HTPs and the 
growing trend identified in the literature (see section 5.1).  

The primary data collection activities focussed on covering the identified gaps. The focus groups 
were a useful tool to collect qualitative information and to provide an in-depth understanding of 
representations of consuming different products, as well as consumption careers and transitions. 
Table 8 shows the key topics addressed in the focus group discussions.  

Table 8. Data gaps addressed by the focus group  

Tool / methodology 

Issues Addressed 

Focus Group  

• 

• 

The pattern of use of the different tobacco products; 

Perception of risk and harmfulness;  

•  Health, social and economic impacts; and,  

•  Opinions and ideas on regulation. 

Source: Own elaboration 

Technical Appendix V provides a more detailed description of the methodology used to carry out 
the Focus Group. Technical Appendix VI also provides the guidelines applied by the moderators 
to carry out this research activity.  

24 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

1.3.3 Online survey  

The online survey was designed to collect quantitative data to fill the information gaps identified 
in  the  systematic  review.  Overall,  12,000  respondents  took  part  and  in  addition  to  the  five 
countries  in  which  the  focus  groups  were  conducted,  a  further  five  EU  Member  States  were 
selected to achieve geographic representativeness of the sample and to cover markets that were 
relevant for particular tobacco and related products. The final list of countries is shown in Table 
9. The respondents were selected on the basis of quotas in order to (i) survey sufficient numbers 
of  users  of  the  five  product  categories  and  (ii)  and  on  account  of  the  concerns  about  young 
people’s use of tobacco and related product to over-sample people aged 18-25. For each of the 
ten countries the samples were as follows and displayed in table 9: 

  600 users of tobacco and related products (including those who had quit in the last 12 

months) aged 26 years and above.  

  600 young people aged 18 to 25 (including users and non-users)  

Socio-demographic profiles of the survey samples can be found in Table 12 and Table 13. 

Table 9. Online survey: Geographic scope and quota breakdown by country (N=12,000) 

Youth respondents 
(aged 18 to 25) 

Consumers of 
tobacco and related 
products15 

Total # 
respondents 

Country 

Bulgaria (E) 

France (W) 

Germany (C) 

Greece (S) 

Italy (S) 

Latvia (N) 

Poland (E) 

Slovakia (C) 

Spain (S) 

United 
(W)  

Kingdom 

Source: Own elaboration 

610 

606 

603 

610 

601 

603 

609 

643 

605 

600 

777 

634 

625 

718 

664 

617 

696 

626 

759 

644 

1200 

1200 

1200 

1200 

1200 

1200 

1200 

1200 

1200 

1200 

Latvia was chosen due to its medium-high consumption rates as well as its consumption of slim 
cigarettes and waterpipe tobacco, according to the latest Eurobarometer. Poland was the most 
relevant market for slim cigarettes given its size and relatively high usage. Slovakia was included 
since  the  national  authorities  had  recently  reported  high  rates  of  forecast  growth  for  HTPs. 
Increasing trends in volume sales were also observed for Slovakia in the Passport data. The UK 
was the country with the highest share of e-cigarette users. Italy was an early adopter of HTPs 
(Liu et al., 2018) and was included as it was important to have a country in which HTPs had 
been present in the market for a longer time. 

Table 10 maps the way in which the online survey was used to fill in the identified information 
gaps (see Technical Appendix VIII for the full online questionnaire).  

15 Including those that had quit in the last 12 months 

25 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Table 10. Data gaps addressed by the Online survey 

Tool / methodology 

Issues Addressed 

Online survey  

• 

• 

• 

• 

• 

Consumption history; 

Initiation, switching and cessation of different tobacco products; 

Perceived harmfulness of the different products; 

Awareness and perceptions of emerging products; 

Consumer demographics. 

Source: Own elaboration 

The online survey used questions and response alternatives that are typical of Eurobarometer 
surveys. An exception was the adoption of a novel form of questioning about health risk in health 
research. To assess the perceived harmfulness of the 5 tobacco products, a ‘swing’ methodology 
was  used.  The  procedure  is  as  follows.  Respondents  were  asked  to  think  about  the  potential 
‘damage to health’ of the five products under scope, as well as conventional cigarettes, and to 
select the product that they considered most damaging to health. They were then told that this 
product has been allocated 100 points on a  ‘damage to health’ scale’ running from 100 (high 
damage) to 0 (no damage). Respondents were then asked to assess the five remaining tobacco 
and  related  products  on  the  100-point  scale,  giving  a  relative  damage  to  health  score  for  all 
products. So, for example, if a respondent rated slim cigarettes as the most damaging to health 
of the tobacco and related products, slim cigarettes were rated at 100. If the respondent then 
rates  e-cigarettes  at  50,  that  implies  that  the  respondent  thinks  e-cigarettes  are  half  as 
damaging to health as are conventional cigarettes. Whether the size of slim cigarettes reduces 
the  perceived  ‘damage  to  health’  is  one  of  the  interesting  questions  for  the  analyses  of  the 
survey. The following question focused on the ‘potential damage to health of other people’ and 
used the same method to elicit judgements of the relative extent of damage to health of ‘passive 
smoking’ from the five products. 

Table  11  maps  how  the  survey  addressed  for  each  product  category  the  research  aspects 
identified in the gap analysis, for each product category.  

26 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 11. Mapping of survey questionnaire by research question 

Small cigarillos 

Waterpipe tobacco 

Electronic cigarettes 

Novel tobacco products 

Slim cigarettes 

Demography of user population 

Market developments 

Age 
Gender 
Education level 

Socioeconomic status 

Regional Distribution 
Pattern of use  

Frequency 

Quantity 

Duration of use 

Q5.2 
Q5.1 
Q5.3 

Q5.6 

Q5.4 

Q5.2 
Q5.1 
Q5.3 

Q5.6 

Q5.4 

Q5.2 
Q5.1 
Q5.3 

Q5.6 

Q5.4 

Q5.2 
Q5.1 
Q5.3 

Q5.6 

Q5.4 

Q5.2 
Q5.1 
Q5.3 

Q5.6 

Q5.4 

Q1.3; Q1.6 

Q1.4.a 

Q1.3; Q1.6 

Q1.4.a 

Q1.3; Q1.6 

Q1.4.b; Q1.4.c 

Q1.3; Q1.6 

Q1.4.a 

Q1.3; Q1.6 

Q1.4.a 

Q1.2.a; Q1.2.b; Q5.2 

Q1.2.a; Q1.2.b; Q5.2 

Q1.2.a; Q1.2.b; Q5.2 

Q1.2.a; Q1.2.b; Q5.2 

Q1.2.a; Q1.2.b; Q5.2 

Parallel  use  of  other 
tobacco products 
Initiation of use 

Q1.1 

Q1.1 

Q1.1 

Q1.1 

Q1.1 

Age 

Determinants 
Link 
products 
Cessation 

to  use  of  other 

Q1.2.a; Q1.2.c 
Q2.1.a; Q2.1.b 

Q1.2.a  
Q2.1.a; Q2.1.b 

Q1.2.a  
Q2.1.a; Q2.1.b 

Q1.2.a  
Q2.1.a; Q2.1.b 

Q1.2.a  
Q2.1.a; Q2.1.b 

Q1.1; Q2.6; Q2.7; Q2.8 

Q1.1; Q2.6; Q2.7; 
Q2.8 

Q1.1; Q2.6; Q2.7; Q2.8; 
Q4.9 

Q1.1; Q2.6; Q2.7; Q2.8; Q4.3 

Q1.1; Q2.6; Q2.7; Q2.8 

Frequency  
Short-term results 

Long-term results 

Q1.5; Q2.3 
Q2.2; Q2.3; Q2.4 

Q1.2.b; Q2.4 

Q1.5; Q2.3 
Q2.2; Q2.3; Q2.4 

Q1.5; Q2.3 
Q2.2; Q2.3; Q2.4 

Q1.2.b; Q2.4 

Q1.2.b; Q2.4 

Q1.5; Q2.3 
Q2.2; Q2.3; Q2.4 

Q1.2.b; Q2.4 

Q1.5; Q2.3 
Q2.2; Q2.3; Q2.4 

Q1.2.b; Q2.4 

Consumer perceptions 

Harmfulness 

Awareness and perceptions 
of emerging products 

Q3.1.a; Q3.1.b; Q3.1.c; 
Q3.2.a; Q3.2.b 

Q3.1.a; Q3.1.b; 
Q3.1.c; Q3.2.a; Q3.2.b 
Q4.15;  Q4.16;  Q4.17; 
Q4.18 

Q3.1.a; Q3.1.b; Q3.1.c; 
Q3.2.a; Q3.2.b 
Q4.9;  Q4.10;  Q4.11; 
Q4.12; Q4.13; Q4.14 

Q3.1.a; Q3.1.b; Q3.1.c; Q3.2.a; 
Q3.2.b 
Q4.1;  Q4.2;  Q4.3;  Q4.4;  Q4.5; 
Q4.6; Q4.7; Q4.8; Q4.9; Q4.10 

Q3.1.a; Q3.1.b; Q3.1.c; Q3.2.a; 
Q3.2.b 

Source: Own elaboration 

27 

 
 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 12 and Table 13 provide a description of the sample of respondents from the online survey. The 
first table describes the 18 to 25 age sub-group (hereinafter referred to as 18-25 age group), while 
the second table focusses on the sample group of people aged 26 years and above (henceforth 26+ 
age group). Both tables provide values for each of the countries in percentage terms, as well as the 
absolute number of respondents in the first row. The sub-samples are described by gender, education 
level, employment status, residency and self-reported socio-economic status. A detailed breakdown, 
in number of respondents and shares, can also be found in the Annex 10.1.  

Table 12. Socio-demographic breakdown of online survey (18-25 age group) 

Percentage and number of respondents in the 18-25 age group 

18-25 age 
group  

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

(6090) 

(610) 

(603) 

(610) 

(605) 

(606) 

(601) 

(603) 

(609) 

(643) 

(600) 

Total number (in 
absolute values) 

Gender 

Male % 

Female % 

Education 

Low % 

Medium % 

High % 

Employment 
Status 

Self-employed % 

Managerial 
position % 
Other white collar 
% 

Manual worker % 

Unemployed % 

Retired % 

Student % 

Non-employed % 

Residency 

Urban % 

Suburban % 

Rural % 

47 

53 

6 

63 

32 

9 

6 

18 

13 

9 

0 

42 

4 

65 

19 

16 

47 

53 

5 

63 

32 

14 

8 

20 

16 

8 

0 

31 

2 

87 

8 

5 

43 

57 

3 

72 

24 

4 

4 

17 

22 

3 

0 

46 

3 

54 

19 

27 

11 

65 

25 

49 

51 

2 

56 

42 

13 

2 

15 

4 

13 

0 

50 

2 

76 

16 

8 

20 

67 

13 

49 

51 

3 

59 

38 

11 

3 

20 

10 

9 

0 

45 

1 

73 

17 

9 

12 

68 

20 

50 

50 

9 

46 

46 

9 

5 

15 

13 

5 

0 

42 

10 

59 

21 

21 

21 

57 

22 

50 

50 

4 

70 

25 

7 

2 

15 

5 

12 

0 

55 

4 

55 

30 

16 

14 

67 

19 

39 

61 

10 

60 

31 

11 

8 

25 

9 

10 

0 

31 

5 

73 

16 

11 

20 

64 

16 

49 

51 

4 

73 

22 

6 

7 

19 

17 

7 

0 

42 

2 

67 

17 

16 

20 

70 

10 

43 

57 

9 

66 

25 

5 

6 

12 

13 

8 

0 

51 

4 

59 

8 

33 

20 

69 

12 

50 

50 

5 

63 

32 

9 

14 

17 

18 

11 

0 

25 

5 

46 

43 

11 

26 

57 

17 

Self-reported socio-economic status 

Low % 

Medium % 

High % 

18 

65 

17 

22 

65 

13 

Base: all respondents in the 18-25 age group (N=6,090) 

Notes: The group total category refers to all respondents within the age group. The orange 
column represents the share of respondents in the age group that have this trait, i.e. it is the 
socio-demographic  breakdown  for  the  whole  age  group.  The  white  columns  represent  the 
country breakdown. The first row provides the absolute number of respondents per country. 
Source: OE elaboration from online survey data 

28 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 13. Socio-demographic breakdown of online survey (26+ age group) 

Percentage and number of respondents in the 26+ age group) 

26+ age group 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

(5910) 

(590) 

(597) 

(590) 

(595) 

(594) 

(599) 

(597) 

(591) 

(557) 

(600) 

Total number (in 
absolute values) 

Gender 

Male % 

Female % 

Education 

Low % 

Medium % 

High % 

Employment status 

Self-employed % 

Managerial 
position % 
Other white collar 
% 

Manual worker % 

Unemployed % 

Retired % 

Student % 

Non-employed % 

Residency 

Urban % 

Suburban % 

Rural % 

52 

48 

5 

46 

49 

14 

13 

30 

16 

7 

12 

2 

6 

66 

17 

17 

51 

49 

1 

32 

66 

18 

15 

37 

17 

4 

6 

1 

2 

94 

4 

3 

Self-reported socio-economic status 

Low % 

Medium % 

High % 

23 

64 

13 

27 

65 

8 

57 

43 

14 

61 

25 

9 

13 

22 

18 

7 

23 

2 

6 

52 

19 

28 

19 

59 

22 

50 

50 

1 

32 

67 

19 

7 

41 

7 

6 

6 

2 

2 

80 

13 

6 

20 

68 

12 

50 

50 

2 

40 

58 

16 

13 

36 

17 

6 

5 

2 

4 

80 

12 

8 

14 

71 

15 

47 

53 

14 

37 

49 

12 

4 

27 

20 

6 

17 

1 

13 

46 

17 

37 

26 

60 

14 

49 

51 

9 

50 

41 

18 

7 

35 

7 

10 

6 

4 

12 

64 

22 

14 

19 

66 

15 

62 

38 

5 

46 

49 

15 

16 

28 

17 

6 

9 

1 

7 

72 

13 

15 

29 

62 

9 

49 

51 

2 

43 

55 

11 

16 

35 

19 

3 

11 

2 

3 

78 

11 

11 

23 

66 

12 

57 

43 

2 

63 

35 

11 

11 

24 

25 

4 

19 

1 

5 

64 

9 

28 

27 

62 

11 

49 

51 

2 

54 

44 

9 

24 

18 

12 

6 

19 

1 

10 

27 

50 

23 

30 

59 

12 

Base: all respondents in the 26+ age group (N=5,910) 

Notes: The group total category refers to all respondents within the age group. The orange 
column represents the share of respondents in the age group that have this trait, i.e. it is the 
socio-demographic  breakdown  for  the  whole  age  group.  The  white  columns  represent  the 
country breakdown. The first row provides the absolute number of respondents per country. 

Source: OE elaboration from online survey data 

29 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

1.4  Rationale of the report  

This report is structured into 8 chapters. In the introductory chapter, an overview of the state of 
the  art  is  provided  together  with  the  overall  objectives  and  scope  of  the  study.  The  chapter  also 
describes the design  and approach used to answer the different research questions  by highlighting 
which information source was used and how it was collected.  

The following five chapters (chapter 2 to 6) describe in a structured way the results found for each of 
the five tobacco and related products within scope. Each chapter starts with a background section 
that  summarises  the  state-of-the-art  developed  during  the  preparatory  phase  (systematic  review). 
The initial section is followed by three sections which detail the main findings for each of the overall 
study objectives: 

  Market developments 
  Consumer perceptions 
  Health, social and economic impacts 

Findings from the online survey have been structured to highlight information for two different age 
sample groups: the ‘18-25 age group’ and the ‘26+ age group’. The chapters on individual products 
conclude with a triangulation of the different sources and a discussion of the key points identified for 
each product. 

Common terminology is used throughout the text to refer to the types of user identified. Never users 
refer to respondents in the online survey who had never used a particular product (e.g. “never user 
of e-cigarettes”) at the time of the survey. People that tried the product refers to respondents that 
said they had only tried a specific product once or twice. Past users respondents that had consumed 
a specific product more than once or twice in the past but have not used the product in the 12 months 
prior to the survey. Current users refer to survey respondents that had consumed a specific product 
more than once or twice in the last 12 months prior to the survey. Exclusive users refer to respondents 
that only used one particular product at the time of the survey. Dual users refers to those who, at the 
time of the survey were using more than one of the tobacco and related products. 

Chapter  7  provides  a  comparative  analysis  of  the  primary  data  collected  across  the  different 
products as well as traditional cigarettes. The chapter is divided into three sections, one for each of 
the overall study objectives. Chapter 8 provides the conclusions of the study.  

The Annexes present additional data tables that are complementary to the core related analysis of the 
five  tobacco  and  related  products  covered  in  this  study.  The  Technical  Appendices  are  found  in  a 
separate document and gather the detailed methodologies used to carry out the activities under the 
present study as well as data sources produced in the context of the report. 

30 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

2  Waterpipe tobacco  

2.1  Background 

Over the past 30 years the consumption of waterpipe tobacco has become more prevalent particularly 
among young adults and college students (EC, 2010). In parallel, there has been a global increase in 
the  waterpipe  tobacco  market.  Most  of  the  literature  on  waterpipe  tobacco  has  a  focus  on  North 
America  and  the  Middle  East,  paying  special  attention  to  the  product  use  by  young  people  (Al 
Moamary,  2011,  Saudi  Arabia;  Abdullah,  2016,  Canada,  N=20.703;  Rahman,  2012,  USA,  N=478; 
Minaker, 2015, Canada, N=27.404). As identified by a recent study, there was a notable scarcity of 
data on the trade and consumption of waterpipe tobacco products in the EU,16 but the recent increase 
in popularity of the product signalled the need for more information on the product. In a systematic 
review, Jawad et al. (2018, global) marked Europe as one of two regions with the highest prevalence 
of waterpipe tobacco use amongst youth.17 He had previously noted a particularly high use of waterpipe 
products  among  those  aged  13  to  15  years  in  parts  of  Eastern  Europe  (Latvia  22.7%,  the  Czech 
Republic 22.1%, Estonia 21.9%) through a secondary analysis of the Global Youth Tobacco Survey18 
(Jawad, 2015, EU).  

Market developments. According to Passport data, Germany was the largest market of waterpipe 
tobacco19 in the EU in 2017 with 368 million euros (m EUR) in retail volumes, representing over half 
of the whole European market. It was followed by the UK (79 m EUR), Spain (56 m EUR) and France 
(52 m EUR). It is important to note that, in the Passport data, waterpipe tobacco includes cut tobacco 
sold in packaged format for smoking in both pipes and waterpipes. While this is likely to overestimate 
waterpipe consumption, it is the best proxy for the market. 

Figure 3. Market size of waterpipe & pipe tobacco products in million EUR in 2017 

Note: Category of the waterpipe tobacco includes cut tobacco sold in packaged format for smoking in pipes 
and  water  pipe  tobacco.  The  market  size  is  estimated  total  sales  in  million  euros  for  2017,  without 

16 European Commission (2017): Study on Council Directive 2011/64/EU on the structure and rates of excise duty applied to 
manufactured tobacco.  
17 The other region was the Middle East, for both youth and adults.  
18 A nationally representative study of students aged 13-15 years 
19 Category of the waterpipe tobacco includes cut tobacco sold in packaged format for smoking in pipes and water pipe tobacco. 

31 

 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

population adjustments. It is displayed as a tree map graph that consists of series of nested rectangles of 
sizes proportional to the corresponding data value. 
Source: OE elaboration of Passport, 2017 

A European Commission study20 revealed that tax evasion was particularly high in the case of pipe 
and waterpipe tobacco, resulting in the creation of a black market for the product and revenue loss. 
The  wide  range  of  prices  for  waterpipe  tobacco  in  the  Member  States  is  likely  to  have  been  a  key 
driver  for  cross-border  selling  in  the  EU.  These  developments  have  hindered  the  effectiveness  of 
tobacco control measures. A recent EU-level study (EC, 2020) suggested that the impact of taxation 
on dissuading youth from tobacco consumption has been lower than expected, due  inter alia to the 
substitution  of  cigarettes  with  less  expensive  products,  including  waterpipe  tobacco.21  Indeed,  for 
excise duty purposes, waterpipe tobacco falls within the residual category of “other smoking tobacco” 
for excise duty purposes22 (see art. 2.1(c) in the Directive 2011/64 (‘Tobacco Excise Directive’ – TED 
23). As depicted in Figure 4., the highest prices for pipe and waterpipe tobacco were found in Sweden 
and  Ireland,  two  markets  that  were  not  observed  as  particularly  relevant  for  waterpipe  tobacco 
products (see Figure 3.). On the contrary, in the largest market, Germany, prices (€115 per kg) were 
below the EU average of €201 per kg. 

Figure 4. Price of waterpipe and pipe tobacco products across EU in 2017, euros per kg 

Note: EU average is calculated for 25 EU members (excluding Cyprus, Luxembourg and Malta). Category 
of the waterpipe tobacco includes cut tobacco sold in packaged format for smoking in pipes and water pipe 
tobacco. 
Source: OE elaboration of Passport, 2017 

The market dynamics over the period 2012-2017 showed a small decrease in the sales of pipe and 
waterpipe  tobacco  for  a  majority  of  EU  Member  States,  with  the  notable  exceptions  of  Romania, 
Germany, Slovenia, Bulgaria and Portugal, where market volumes increased considerably (see Figure 
5.). The most significant increase compared to the year 2012 occurred in Romania, where the market 
size increased almost by a ten-fold in terms of both retail sale price (RSP) and real volume. 

20 European Commission (2017): Study on Council Directive 2011/64/EU on the structure and rates of excise duty applied to 
manufactured tobacco 
21 https://ec.europa.eu/taxation_customs/sites/taxation/files/10-02-2020-tobacco-taxation-report.pdf  
22 In standard economic theory, excise duty increases the price of a product and therefore is expected to decrease demand.  
23 Directive 2011/64/EU on the structure and rates of excise duty applied to manufactured tobacco. Available at: https://eur-
lex.europa.eu/legal-content/en/ALL/?uri=CELEX%3A32011L0064 

32 

0,050,0100,0150,0200,0250,0300,0350,0400,0450,0ESPTBEDEHUATITLTSIBGHRPLFRCZEEEULVNLDKELSKROFIUKIESE 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 5. Market size trends of waterpipe & pipe tobacco products: 2012-2017  

Note: RSP stands for retail selling price in the graph (current prices). The EU average is calculated for 25 
EU MS only (excluding Cyprus, Luxembourg & Malta - no data were available). Category of the waterpipe 
tobacco includes cut tobacco sold in packaged format for smoking in pipes and water pipe tobacco. 
Source: OE elaboration of Passport, 2017 

There has been  evidence  of the growing popularity of waterpipe tobacco consumption (Kilibarda  et 
al.,  2019;  EC,  2017),  although  the  extent  of  use  varies  greatly  across  EU  Member  States  (Jawad, 
201824). For instance, Jawad (2018) estimated that there were many fewer ‘ever users’ of waterpipe 
tobacco in the UK (9.9%) than in Germany (28.9%) and Finland (15.3%). A considerable  surge in 
popularity has particularly been noted in younger generations. Several studies  found an alarmingly 
high prevalence of waterpipe tobacco  recurrent users  specifically among high school students (Akl, 
2011, global; Jawad et al., 2013, UK; Jawad, 2016, global; Jawad, 2018, UK). One study estimated 
that the prevalence of waterpipe recurrent use was 1.5 times higher than cigarette smoking amongst 
school  students  in  Europe,  a  concerning  development  as  it  may  encourage  the  use  of  tobacco  and 
related products (Akl, 2011). Data from the Eurobarometer 458 found that 28% of young people aged 
15-24 reported having tried waterpipe tobacco products – over twice as many as in the overall sample 
(13%). In a meta-analysis, Jawad (2015, EU) estimated higher odds of waterpipe tobacco smoking 
amongst males, cigarette users, those whose parents or peers smoked and those whose parents had 
higher  educational  attainment.  To  this  list,  Grant  et  al.  (2014)  added  adults  with  a  higher  socio-
economic  status,  while  Balogh  (2018,  Germany  &  Hungary,  N=2,935)  showed  that  there  was  no 
association between the financial situation of university students and waterpipe tobacco consumption.  

In terms of patterns of use, data suggested that most consumers of waterpipe tobacco only use the 
product occasionally, often in social settings (EC, 2010). Many studies have explored the dual use of 
waterpipe  tobacco  with  other  tobacco  products  and  documented  that  being  a  concurrent  user  of 
cigarettes was strongly correlated with waterpipe tobacco use (Akl, 2011; Jawad et al., 2018; Balogh, 
2018)  (see  section  2.4  for  health impacts  of  dual use).  For  instance,  over  10%  prevalence  of  dual 
waterpipe tobacco and cigarette use was reported in Eastern European countries (Jawad, 2015). Al 

24 Data was used from four different survey waves: N=2,062 (2013); N=1,952 (2014); N=1,943 (2015); N=2,019 (2016). 

33 

-100-50050100150200250300ATBEBGCYCZDEDKEEELESFIFRHRHUIEITLTLULVMTNLPLPTROSESISKUKEU% growth in RSP% growth in real volume9009501000 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Oweini et al. (2018) analysed waterpipe tobacco consumption in light of the gateway hypothesis and 
found  that  those  using  waterpipe  tobacco  products  had  double  the  odds  of  starting  to  consume 
cigarettes later.  

Consumer perception. The increase in the popularity of waterpipe tobacco has been attributed to 
the  social  culture  of  waterpipe  use,  to  the  lack  of  awareness  about  the  harmful  health  effects  of 
waterpipe tobacco use, and to aggressive marketing by the industry through various social channels 
(Balogh  et  al.,  2018;  Maziak  et  al.,  2015;  Singh,  2017)  –  specifically  targeting  younger  consumer 
groups. Several studies, mainly from the USA, have looked at the effect of the mass media and social 
network environments on young people’s perception of waterpipe tobacco products. Nevertheless, due 
to the global access of online content, the findings may also be considered relevant to Europeans. In 
a systematic literature review, Singh et al. (2017) analysed the factors that drove youth to waterpipe 
smoking  initiation.  The  factors  were  categorised  as:  (i)  individual  factors,  including  curiosity, 
perception/attitude  towards  waterpipe  smoking  and  pleasure  seeking;  (ii)  interpersonal  influences, 
including the influence of family and friends; (iii) cigarette and alcohol use, as waterpipe can be used 
as a substitute for conventional cigarettes, and (iv) media influences. Of these, interpersonal factors 
were the most influential. 

Primack (2012, USA) analysed the way in which establishments dedicated to hookah tobacco smoking 
advertised  their  services  on  the  Internet.  He  reported  that  their  promotional  material  aimed  to 
cultivate  an  image  of  highly  social,  cultural  and  fun  places  for  young  people,  with  relatively  few 
mentions of health warnings. Jackler (2019, USA) found that tobacco marketing was still prevalent on 
Facebook, despite efforts from the platform to ban it. Brand-sponsored pages were often found to use 
content  strategies  to  engage  users,  for  example,  through  memes,  sponsored  events,  product 
innovations  and  contests  to  attract  “likes”.  These  commercial  practices  allowed  tobacco  brands  to 
escape  the  scrutiny  of  regulations  on  tobacco  promotion,  while  potentially  shaping  the  views  of 
vulnerable  groups.  In  Europe,  the  waterpipe  industry,  including  waterpipe  cafes,  has  been  said  to 
operate in an almost completely unregulated market and to employ deceptive marketing techniques 
to  attract  new  users  (Jawad,  2013,  UK).  Cultural  and  commercial  factors  –  such  as  the  social 
acceptability  of  the  shisha  lounge  culture  or  the  introduction  of  flavoured  tobacco  blends  –  were 
believed to be key drivers behind the recent growth in the market in the region.25 A recent systematic 
review found that the most cited reasons for waterpipe tobacco use amongst university students in 
the  global  north  –  namely,  Europe,  United  States  and  Australia  –  were  curiosity,  peer  or  social 
influence,  and  wanting  to  overcome  the  social  anxiety  associated  with  new  situations  whilst  still 
engaging  in  a  legal  activity  (Arshad  et  al.,  2019).  Research  has  shown  evidence  that  youth  were 
particularly attracted to the product due to the range of “appealing” flavours available (Qasim et al., 
2019,  global).  In  terms  of  perception  of  harmfulness,  qualitative  research  around  the  world  has 
evidence  lower  harm  perception  compared  to  cigarettes  (Ali  &  Jawad,  2017;  Jawad  et  al.,  2013; 
Cornacchione  et  al.,  2016).  Jorge  (2018,  N=1,770)  explored  the  perceptions  of  waterpipe  tobacco 
products among Spanish teenagers, aged 12-18 years. In general, the teenagers viewed waterpipe 
use as less harmful and less addictive than conventional cigarettes. In a more recent global study, 
Arshad et al. (2019) found that although students knew about the harms associated with waterpipe 
tobacco,  it  did  not  seem  to  deter  them  from  using  the  product  –  a  finding  that  differs  from  global 
studies on adult waterpipe tobacco users (Akl et al., 2015). 

Impacts. Overall, most studies on health impacts agreed that users of waterpipe tobacco products 
were exposed to many of the same toxic compounds and by-products as conventional cigarette users, 
and potentially at much higher levels. The health, economic and social impacts are further developed 
in section 2.4.  

25 https://ec.europa.eu/taxation_customs/sites/taxation/files/study_on_directive-2011_64_main_text_en.pdf 

34 

 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

2.2  Market developments  

2.2.1 Socio-demographic characteristics  

The online survey found that there was a high prevalence of waterpipe tobacco use in the 18-25 age 
group. Over half of the respondents (53%) had used the product at least once or twice. Spain showed 
a particularly high consumption rate with one fifth (19%) of respondents reporting current waterpipe 
use in the 18-25 age group. There  were considerably fewer current users in Latvia (5%) and  Italy 
(4%), although two fifth (41%) of  respondents in Latvia reported having tried  the product  once or 
twice.  Across  the  Member  States  included  in  the  survey,  the  percentages  of  those  who  had  tried 
waterpipe tobacco was typically higher than current users, suggesting that many respondents in the 
18-25 age group had experimented with the product but did not continue using them. The findings of 
the  online  survey  were  echoed  in  the  focus  groups  in  which  participants  from  Spain,  France  and 
Germany commented on a recent surge in waterpipe tobacco popularity. 

In the 26+ age group, there were 6% of current users on average across the MS studied. Spain was 
once again the leading market for waterpipe tobacco consumption with 9% of reporting current use. 
The UK and France were particularly small markets with 83% and 79% respectively reporting having 
never  used  waterpipes.  Latvia  showed  a  similar  pattern  as  the  one  noted  in  the  18-25  age  group. 
While it had one of the lowest shares of current users (4%), two fifths (40%) of respondents had tried 
the product once or twice. Overall, waterpipe use in the 26+ age group was lower than in the younger 
age group. There was a large majority of never users in the 26+ age group (65%) while less than half 
of respondents in the 18-25 group (47%) were never users of waterpipe tobacco. The findings from 
the focus group confirmed that the product was mainly associated to younger generations: 

“Well if I were with elders, I wouldn’t take out a hookah.” (M, 31, ES) 

“Many minors smoke it.” (M, 20, ES)  

Figure 6. Use of waterpipe: country breakdown (18-25 age group) 

Percentage of all respondents in the 18-25 age group 

Base: all respondents in the 18-25 age group (N=6,090) 
Question: Q.1.1. Have you ever used waterpipe tobacco? 
Note: The group total category refers to all respondents within the age group. 
Source: OE elaboration from online survey data 

35 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 7. Use of waterpipe: country breakdown (26+ age group) 

Percentage of all respondents in the 26+ age group 

Base: all respondents in the 26+ age group (N=5,910) 
Question: Q.1.1. Have you ever used waterpipe tobacco? 
Note: The group total category refers to all respondents within the age group.  
Source: OE elaboration from online survey data 

36 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 14 and Table 15 present a socio-demographic breakdown for each age group. For the 18-25 age 
group the differences were marginal in terms of gender and education level. Users were more likely 
to come from urban settings and to have reported higher socio-economic status. A similar pattern was 
observed  for  the  26+  age  group.  Urban  residency  and  high  reported  socio-economic  status  were 
associated with waterpipe use.  

Table 14. Waterpipe use socio-demographic breakdown (18-25 age group) 

Percentage and number of respondents in the age group 18 to 25 

Group total 
% (n) 
100 
(6090) 

Current users 
% 

Past users 
% 

Used once or twice 
% 

Never used 
% 

11 

15 

27 

47 

Use of product 

Gender 

Male 

Female 

Education level26 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

47 
(2869) 
53 
(3221) 

5 
(335) 
63 
(3829) 
32 
(1926) 

65 
(3949) 
19 
(1173) 
16 
(968) 

13 

9 

13 

11 

12 

12 

9 

7 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

18 
(1126) 
65 
(3954) 
17 
(1010) 

8 

10 

17 

16 

14 

16 

14 

17 

16 

15 

12 

13 

15 

19 

24 

31 

21 

27 

29 

28 

24 

27 

27 

29 

21 

47 

46 

50 

49 

42 

44 

51 

54 

53 

46 

43 

Base: all respondents in the 18-25 age group (N=6,090) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

26  Note:  (1)  No  official  education;  (2)  Primary  school;  (3)  High  school;  (4)  Some  years  of  university  (not  completed);  (5) 
University degree completed; (6) Post-graduate (master, PhD, other) 

37 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Table 15. Waterpipe use socio-demographic breakdown (26+ age group) 

Percentage and number of respondents over the age of 26 

Group total 
% (n) 

Current 
users 
% 

Past 
users 
% 

Used once 
or twice 
% 

Never used 
% 

Use of product 

Gender 

Male 

Female 

Education level27 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 
(5910) 

52 
(3074) 
48 
(2836) 

5 
(308) 
46 
(2704) 
49 
(2898) 

66 
(3879) 
17 
(1010) 
17 
(1021) 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

23 
(1374) 
64 
(3769) 
13 
(767) 

6 

7 

5 

6 

4 

7 

7 

5 

2 

3 

5 

8 

8 

7 

6 

6 

9 

9 

7 

5 

5 

8 

15 

12 

21 

65 

22 

21 

14 

19 

25 

23 

20 

16 

20 

22 

22 

63 

67 

74 

71 

58 

61 

69 

77 

72 

65 

51 

Base: all respondents in the 26+ age group (N=5,910) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

27  Note:  (1)  No  official  education;  (2)  Primary  school;  (3)  High  school;  (4)  Some  years  of  university  (not  completed);  (5) 
University degree completed; (6) Post-graduate (master, PhD, other) 

38 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

2.2.2 Pattern of use  

Figure 8 shows that in the 18-25 age group, one fifth of current users (20%) reported daily use of the 
product, and 35% reported weekly usage. Although there were fewer current users in the 26+ age 
group (see Figure 9) those that did used the product appeared to do so more often: a quarter (25%) 
reported waterpipe use daily and close to two fifths (37%) reported using waterpipe tobacco weekly. 

Figure 8. Frequency of use of current waterpipe users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of waterpipe tobacco in the 18-25 age group (N=668) 
Question: Q.1.3. How often do you use waterpipe (i.e. shisha & narghile) tobacco? 
Source: OE elaboration from online survey data 

Figure 9. Frequency of use of current waterpipe users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of waterpipe tobacco in the 26+ age group (N=339) 
Question: Q.1.3. How often do you use waterpipe (i.e. shisha & narghile) tobacco? 
Source: OE elaboration from online survey data 

39 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 10 and Figure 11 show that, in both age groups, only about one in ten past users reported daily 
use of waterpipes, considerably fewer than current users. On the criterion of use ‘every day and about 
once a week ’ there were 55% of users in the 18-25 age group and 62% in the 26+ age group. This 
compares  with  43%  and  51%  among  the  past  users  an  indication  of  the  increasing  popularity  of 
waterpipe tobacco.  

Figure 10. Frequency of use of past waterpipe users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: past users of waterpipe tobacco in the 18-25 age group (N=913) 
Question: Q.1.6. How often did you use waterpipe (i.e. shisha & narghile) tobacco? 
Source: OE elaboration from online survey data 

Figure 11. Frequency of use of past waterpipe users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: past users of waterpipe tobacco in the 26+ age group (N=464) 
Question: Q.1.6. How often did you use waterpipe (i.e. shisha & narghile) tobacco? 
Source: OE elaboration from online survey data 

40 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Although users in the 26+ age group consumed waterpipe tobacco more often, the users in the 18-
25 age group reported using the product more intensively. Over two fifths (44%) of current users in 
the 18-25 age group reported consuming it for over 30 minutes per day, compared to 30% in the 26+ 
age group. 

Figure 12. Average number of minutes per day of waterpipe use (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of waterpipe tobacco in the 18-25 age group (N=668) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use waterpipe (i.e. 
shisha or narghile) tobacco? 
Source: OE elaboration from online survey data 

Figure 13. Average number of minutes per day of waterpipe use (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of waterpipe tobacco in the 26+ age group (N=339) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use waterpipe (i.e. 
shisha or narghile) tobacco? 
Source: OE elaboration from online survey data 

41 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 14 and Figure 15 report how much time daily users spend on waterpipes. A majority (60%) of 
the 18-25 years group reported less than 31 minutes per day. The 26+ age group reported the similar 
figure (64%). 

Figure 14. Average number of minutes per day for daily waterpipe users (18-25 age group) 

Percentage and number of daily users in the 18-25 age group  

Base: daily current users of waterpipe tobacco in the 18-25 age group (N=135) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use waterpipe (i.e. 
shisha or narghile) tobacco? 
Source: OE elaboration from online survey data 

Figure 15. Average number of minutes per day, for daily waterpipe users (26+ age group) 

Percentage and number of daily users in the 26+ age group 

Base: daily current users of waterpipe tobacco in the 26+ age group (N=84) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use waterpipe (i.e. 
shisha or narghile) tobacco? 
Source: OE elaboration from online survey data 

42 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

On average, respondents that were under the age of 22 years had on average begun using waterpipe 
tobacco as minors as did other under the age of 32 years. However, on average users between the 
age of 30 and 45 has started using about ten years ag, while the age of initiation for those over 45 
years was more varied. A possible explanation is that waterpipes have become more popular, available 
and socially acceptable in the last 10-15 years.  

Figure 16. Initiation of use for current and past users (waterpipe; total sample) 

Number of current and past users in the total sample 

Base: current and past users of waterpipe tobacco in the total sample (N=2,38428) 
Question: Q.1.2.a. At about what age did you start using waterpipe tobacco? & Q.5.2. Age 
Note: The figure illustrates the approximate starting age of waterpipe tobacco use among all respondents 
in the online survey, where the x-axis represents the current age of the respondent (Q.5.2) and the y-axis 
is the average numbers of years of product consumption (calculated by subtracting the current age from 
the starting age). The orange line represents the 45º or 18 y.o. line. Each blue point represents the average 
starting age for respondents of that age; points above the 18 y.o. line reveal those initiating consumption 
of  waterpipe  tobacco  before  the  age  of  18,  while  those  below  the  line  reveal  age  brackets  starting 
consumption after the age of 18 on average. The blue lines represent the mean standard deviation, i.e. it 
does not show the full range of values for each age.  
Source: OE elaboration from online survey data 

Respondents in the 18-25 age group had on average used the product for 3 years as compared to an 
average of 7 years in the 26+ age group (see Figure 176 and Figure 177). Many reported using the 
product  for 7 to 11 years in the 18-25 age group, which  confirms the  findings above that younger 
respondents had begun using the product as minors.  

Enjoyment and sociability play a key role in the initiation of waterpipe tobacco use across age groups. 
Table 16 reports that 60% of the 18-25 age group cited ‘for enjoyment’ as the reason for taking up 
waterpipe  smoking.  Other  reasons  included  ‘to  socialise’  and  ‘it  was  trendy’  (35%)  and  ‘everybody 

28 NA and misreported values are excluded. 

43 

18 y.o. line  
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

else is smoking’ (18%). Table 17 shows that this pattern of responses held for both current users and 
those who had tried waterpipes once or twice. There is a remarkably similar pattern among the 26+ 
age group with 58% of current and former users citing ‘enjoyment’ and 32% ‘socialising and trendy’.  

Table 16. Reasons for starting to use or trying waterpipe (18-25 age group) 
Percentages by user profile in the 18-25 age group 

Reasons 

For enjoyment 

To socialise / it was trendy  

I was trying to quit or reduce consumption of another product 

I have parents, adults or guardians who smoke* 

To show independence or defiance 

Everyone else is smoking 

Tobacco advertisements 

Base (n) 

Current & past 
users, % 

Used once or 
twice, % 

60 

35 

9 

6 

8 

18 

7 

58 

42 

3 

4 

6 

18 

5 

(1,581) 

(1,622) 

Base: the base of each column is provided in the last row of the table. 
Question: Q.2.1.a. Why did you start using waterpipe tobacco? Please select up to 2 options.  
Q.2.1.b. Why did you try waterpipe tobacco? Please select up to 2 options. 
Note: Each column focusses on a specific consumer profile (i.e. current & past users or used once or twice) 
for the 18-25 age group and provides a breakdown of the reasons identified for starting to use waterpipe 
tobacco. Note that the percentages do not add up to 100% because respondents could select more than 
one term.  
* The type of product ‘smoked’ was not specified in the survey options. 
Source: OE elaboration from online survey data 

Table 17. Reasons for starting to use or trying waterpipe (26+ age group) 

Percentage by user profile in 26+ age group 

Reasons 

For enjoyment 

To socialise / it was trendy  

I was trying to quit or reduce consumption of another product 

I have parents, adults or guardians who smoke* 

To show independence or defiance 

Everyone else is smoking 

Tobacco advertisements 

Base (n) 

Current & past 
users, % 

Used once or 
twice, % 

58 

32 

11 

6 

11 

14 

10 

58 

38 

4 

3 

6 

11 

6 

(803) 

(1,268) 

Base: the base of each column is provided in the last row of the table. 
Question: Q.2.1.a. Why did you start using waterpipe tobacco? Please select up to 2 options. Q.2.1.b. Why 
did you try waterpipe tobacco? Please select up to 2 options. 
Note: Each column focusses on a specific consumer profile (i.e. current & past users or used once or twice) 
for the 26+ age group and provides a breakdown of the reasons identified for starting to use waterpipe 
tobacco. Note that the percentages do not add up to 100% because respondents could select more than 
one term.  
* The type of product ‘smoked’ was not specified in the survey options. 
Source: OE elaboration from online survey data 

44 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 17 and Figure 18 show that 68% of current users in the 18-25 age group had not attempted 
to quit waterpipe tobacco use compared to 51% of the 26+ age group. 

Figure 17. Cessation: attempts to quit waterpipe (18-25 age group) 

Percentage and number of current users in the 18-25 age group  

Base: current users of waterpipe tobacco in the 18-25 age group (N=668)  
Question: Q.1.5. Have you ever tried to quit waterpipe tobacco? If yes, how many times? 
Source: OE elaboration from online survey data 

Figure 18. Cessation: attempts to quit waterpipe (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of waterpipe tobacco in the 26+ age group (N=339)  
Question: Q.1.5. Have you ever tried to quit waterpipe tobacco? If yes, how many times? 
Source: OE elaboration from online survey data 

45 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

About a quarter of respondents in both age categories who had attempted to quit waterpipe tobacco 
use had done so for ‘personal health reasons’ The second most cited reason for attempting to quit in 
the 18-25 age group was ‘smoking restrictions at work/home’,, while it was ‘due to health warning 
messages on the package’ for the 26+ age group.  

Figure 19. Cessation: reasons for trying to quit waterpipe use (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of waterpipe tobacco that tried to quit in the 18-25 age group (N=214)  
Question: Q2.2. What made you try to quit waterpipe tobacco? Please select the most fitting answer (single 
answer). 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

Figure 20. Cessation: reasons for trying to quit waterpipe use (26+ age group) 

 Percentage and number of current users in 26+ age group 

Base: current users of waterpipe tobacco that tried to quit in the 26+ age group (N=166)  
Question: Q2.2. What made you try to quit waterpipe tobacco? Please select the most fitting answer (single 
answer). 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

46 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

For respondents in the 18-25 age group, the most cited reason for starting to use waterpipe tobacco 
again after an attempt to quit was because they believed that waterpipe tobacco was not that harmful 
or  that  it  was  healthier  than  other  products  (27%)  followed  closely  by  ‘stress’  and  ‘my  social 
environment’.  In  the  26+  age  group,  the  ‘social  environment’  was  the  main  reason  for  starting 
waterpipe smoking again (28%) followed by ‘stress’ (24%) 

Figure 21. Reasons for starting to use waterpipe again (18-25 age group) 
Percentage and number of current users in the 18-25 age group 

Base: current users of waterpipe tobacco that tried to quit in the 18-25 age group (N=214)  
Question: Q.2.3. Why did you start to use waterpipe tobacco again? Select up to 2 options.  
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The  percentages  do  not  add  up  to  100%  because  respondents  could  select  more  than  one  answer; 
therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

Figure 22. Reasons for starting to use waterpipe again (26+ age group) 
Percentage and number of current users in the 26+ age group 

Base: current users of waterpipe tobacco that tried to quit in the 26+ age group (N=166)  

Question: Q.2.3. Why did you start to use waterpipe tobacco again? Select up to 2 options.  
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The  percentages  do  not  add  up  to  100%  because  respondents  could  select  more  than  one  answer; 
therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

47 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

2.2.3 Dual use with other tobacco and related products 

Over two thirds (67%)  of current users  of  waterpipe tobacco in the  18-25 group  consumed other 
tobacco  products.  One  in  six  current  users  (17%)  indicated  that  they  had  previously  used  other 
products  but  were  now  only  using  waterpipe  tobacco  products.  A  similar  share  (16%)  had  been 
exclusive users of waterpipe tobacco (see Table 18). A large majority of current users (87%) in the 
26+  group  were  current  dual  users  while  the  share  of  those  that  were  only  consuming  waterpipe 
tobacco now was much lower in this age group (see Table 19). Figure 182 and Figure 183 in Annex 0 
provide  an  indicative  visualisation  of  the  user  scenarios  amongst  current  consumers  of  waterpipe 
tobacco in the 18-25 group and the 26+ age group, respectively.  

The pattern of use can be partially explained by the perception of the product. Focus group participants 
tended to distinguish between waterpipe tobacco and other tobacco products. As the waterpipe was 
not  expected  to  satisfy  tobacco  related  cravings,  users  typically  did  not  regard  its  use  as  “real 
smoking”. 

Table 18. Career flows of use for current waterpipe users (18-25 age group) 

Percentage and number of current users in the 18-25 age group  

Never users of other products 

Total 

Exclusive current user of waterpipe tobacco & past user of other product(s) 

Out of them, switching from (one or more products) * 

Number  % 

668 

107 

113 

100 

16 

17 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

HTPs 

(n=81) 

(n=46) 

(n=42) 

(n=19) 

(n=19) 

72% * 

41% * 

37% * 

17% * 

17% * 

Current user of waterpipe & both current and past user of other product(s)  

448 

67 

Other products consumed in parallel now * 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

HTPs 

(n=337) 

75% * 

(n=281) 

63% * 

(n=226) 

50% * 

(n=188) 

42% * 

(n=219) 

49% * 

in 

the 

users 

18-25 

current 

tobacco 

of  waterpipe 

Base: 
(N=668);  
For  the  rows  in  blue  and  italics,  the  base  is  the  respondents  that  are  current  (exclusive)  users  of  the 
product and that used other products only in the past (N=113) 
Question: Q.1.1. Have you ever used waterpipe tobacco? 
Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  
 (*) Percentages add up to more than 100% on account of the prevalence of dual use.  
Source: OE elaboration from online survey data 

group 

age 

48 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 19. Career flows of current waterpipe users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Never users of other products  

Total 

Exclusive current user of waterpipe tobacco & past user of other product(s) 

Out of them, switching from (one or more products) * 

Number  % 

339 

100 

20 

25 

6 

7 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

HTPs 

(n=19) 

(n=12) 

(n=11) 

(n=5) 

(n=4) 

76% * 

48% * 

44% * 

20% * 

16% * 

Current user of waterpipe & both current and past user of other product(s)  

294 

87 

Other products consumed in parallel now * 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

HTPs 

(n=246) 

84% * 

(n=202) 

67% * 

(n=173) 

59% * 

(n=162) 

55% * 

(n=182) 

62% * 

in 

the 

users 

current 

of  waterpipe 

Base: 
(N=339)  
tobacco 
For the rows in purple and italics, the base is the respondents that are current (exclusive) users of the 
product and that used other products only in the past (N=25) 
Question: Q.1.1. Have you ever used waterpipe tobacco? 
Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  
Source: OE elaboration from online survey data 

group 

26+ 

age 

49 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 20 shows that 44% of past users of waterpipe tobacco in the 18-25 age group, were no longer 
consuming any tobacco or related product (18% had used waterpipe tobacco exclusively and were no 
longer consuming it and 26% were dual past user and not using any products now). Furthermore, 14% of 
past users were exclusive past users of waterpipe tobacco and had transitioned to other tobacco and 
related product(s) – mainly conventional cigarettes.  

Within the 26+ age group (see Table 21), 58% of past waterpipe tobacco users were also current 
users of other tobacco products, and 15% had been exclusive past users who had transitioned to other 
products, mainly conventional cigarettes. 

Table 20. Career flow of past waterpipe users (18-25 age group) 

Percentage and number of current users in the 18-25 age group  

Never users of other products 

Dual past user & not using any products now 

Total 

Exclusive past user of waterpipe tobacco & current user of other products (but not 
waterpipe tobacco) 

Out of them, switching to (one or more products) * 

Number  % 

913 

100 

161 

241 

132 

18 

26 

14 

Cigarettes 

E-cigarettes 

Slim cigarettes 

HTPs 

Small cigarillos 

(n=120) 

91% * 

(n=46) 

(n=27) 

(n=19) 

(n=17) 

35% * 

20% * 

14% * 

13% * 

Dual past user & current user of other products (but not waterpipe tobacco)  

379 

42 

Other products currently consumed * 

Cigarettes 

E-cigarettes 

Small cigarillos 

Slim cigarettes 

HTPs 

(n=260) 

69% * 

(n=123) 

32% * 

(n=42) 

(n=82) 

(n=84) 

11% * 

22% * 

21% * 

Base: past users of waterpipe tobacco in the 18-25 age group (N=913); 
Question: Q.1.1. Have you ever used waterpipe tobacco? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  

(*) Percentages add up to more than 100% on account of the prevalence of dual use.  

Source: OE elaboration from online survey data 

50 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 21. Career flows of past waterpipe users (26+ age group) 
Percentage and number of current users in the 26+ age group 

Never users of other products 

Dual past user & not using any products now 

Total 

Exclusive past user of waterpipe tobacco & current user of other products (but not 
waterpipe tobacco) 

Out of them, switching to (one or more products) * 

Number 

 % 

464 

100 

25 

142 

70 

5 

31 

15 

Cigarettes 

E-cigarettes 

HTPs 

Slim cigarettes 

Small cigarillos 

(n=63) 

(n=31) 

(n=19) 

(n=18) 

(n=12) 

90% * 

44% * 

27% * 

26% * 

17% * 

Dual past user & current user of other products (but not waterpipe tobacco)  

227 

49 

Other products currently consumed in parallel * 

Cigarettes 

E-cigarettes 

Small cigarillos 

Slim cigarettes 

HTPs 

(n=159) 

70% * 

(n=115) 

51% * 

(n=40) 

(n=63) 

(n=64) 

18% * 

28% * 

28% * 

Base: past users of waterpipe tobacco in the 26+ age group (N=464)  
Question: Q.1.1. Have you ever used waterpipe tobacco? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use.  

Source: OE elaboration from online survey data 

51 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

2.3  Consumer perception 

According to focus group participants, the consumption of waterpipe tobacco was an emerging trend 
in  Europe  especially  among  younger  generations.  It  was  also  perceived  as  a  timeless  and  classic 
product due to its long presence on the market. Waterpipe tobacco was considered a non-conventional 
tobacco  product  that  evoked  the  ideas  of  “zen,”  “pleasure,”  and  “relaxation”  amongst  participants. 
Moreover, the use of waterpipe tobacco was sometimes perceived as endemic to specific cultures (e.g. 
Turkish people in Germany).  

“Shisha is being hyped by the rap scene. The youth thinks they are cool using this.” 
(M, 24, DE) 

“(…) Waterpipe tobacco, nowadays it is a new fashion.” (M, 28, ES) 

“Timeless. It has been used for generations” (M, 36, EL)  

In  the  online  survey,  respondents  in  the  18-25  age  group  (see  Table  22)  most  often  associated 
waterpipe  tobacco  with  ‘nice  flavours  (e.g.  apple,  mint)’  with  42%  of  respondents  recording  this 
answer. This was a common view among those who had used the product once or twice. In addition, 
37%  of  respondents  in  this  age  group  characterised  the  product  as  ‘enjoyable’.  Once  again,  this 
response was evident among those who had used waterpipes once or twice, as well as users of the 
product. The more negative terms (e.g. ‘complicated’, ‘unhealthy’ and ‘addictive’) were mainly cited 
by never users. Very few respondents (7%) considered the product to be ‘practical’.  

Table 22. Perception of waterpipe tobacco (18-25 age group) 

Percentage and number of current users in the 18-25 age group  

Group total 
% (n) 

Current 
users % 

Past 
users % 

Used once 
or twice % 

Never 
used % 

Use of product 

Complicated 

Unhealthy 

Costly 

Addictive 

Practical 

Nice flavours (e.g. apple, mint) 

Elegant/trendy/fashionable 

Enjoyable 

100 
(6090) 

20 
(1212) 

35 
(2135) 

24 
(1440) 

24 
(1470) 

7 
(416) 

42 
(2557) 
28 
(1707) 

37 
(2237) 

11 

7 

6 

9 

9 

20 

13 

14 

15 

15 

12 

11 

14 

11 

19 

18 

16 

19 

27 

22 

26 

23 

21 

23 

36 

31 

37 

47 

58 

57 

54 

59 

38 

34 

38 

28 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.15. Which of the following words best captures what you think about waterpipe (e.g. shisha 
& narghile) tobacco? Please tick as many boxes as you would like. 
Note:  The  group  total  column  refers  to  all  respondents  within  the  age  group,  i.e.  it  is  a  within  column 
percentage, e.g. 7% of respondents in this age group selected “practical” to describe waterpipe. The white 
cells (in the four right columns) represent the breakdown by user type, i.e. they are within row percentages 
(white cells in each row sum to 100).  
Source: OE elaboration from online survey data 

52 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

In the 26+ age group, 39% of respondents characterised the product as ‘unhealthy’; this was the 
most often cited term in this age group (see Table 23). ‘Nice flavours’ were also often cited, with 31% 
of  respondents  polling  this  response;  those  that  had  tried  the  product  once  or  twice  were 
overrepresented in the group that provided this response. In short, flavours appeared to be strongly 
linked  to  waterpipe  tobacco  use,  especially  among  the  younger  age  group,  but  respondents  also 
seemed aware of the unhealthy aspect of waterpipe use. 

Table 23. Perception of waterpipe tobacco; 26+ age group) 

Percentage and number of current users in the 26+ age group 

Group 
total 
% (n) 

Current 
users 
% 

Past users 
% 

Used once 
or twice 
% 

Use of product 

Complicated 

Unhealthy 

Costly 

Addictive 

Practical 

Nice  flavours  (e.g.  apple, 
mint) 

Elegant/trendy/fashionable 

Enjoyable 

100 
(5910) 

26 
(1565) 

39 
(2330) 

20 
(1165) 

27 
(1576) 

5 
(293) 

31 
(1842) 

19 
(1106) 

27 
(1619) 

6 

4 

2 

5 

4 

20 

7 

8 

9 

8 

5 

5 

6 

6 

15 

11 

11 

14 

21 

20 

17 

19 

15 

20 

33 

26 

34 

Never 
used 
% 

65 

72 

76 

70 

75 

45 

48 

55 

43 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.15. Which of the following words best captures what you think about waterpipe (e.g. shisha 
& narghile) tobacco? Please tick as many boxes as you would like. 
Note:  The  group  total  column  refers  to  all  respondents  within  the  age  group,  i.e.  it  is  a  within  column 
percentage. The white cells (in the four right columns) represent the breakdown by user type, i.e. they are 
within row percentages (white cells in each row sum to 100).  
Source: OE elaboration from online survey data 

The focus group participants’ views complemented the online survey findings. The range of flavours 
added to the enjoyment of waterpipe tobacco consumption:  

“At the start with cigarettes there were more choices with flavours but now with all 
the  regulations  we  just  have  mint  whereas  with  narghile  we  are  more  open  to 
choices.” (M, 33, FR) 

“When I see things in several flavours, I feel like trying them.” (M, 20, FR) 

“[The  flavours]  They  are  available  everywhere.  Yes,  it  is  an  advantage.”  (M,  25, 
BG) 

While  flavours  were  often  mentioned  as  an  enticing  factor,  participants  in  the  focus  groups  also 
expected the social ritual surrounding waterpipe tobacco consumption and the seemingly lower prices 
to  influence  younger  generations  use  of  the  product.  Indeed,  youth  was  expected  to  have  less 
economic resources and therefore, the intermittent use of the product (as reported in Figure 8 and 

53 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 9) leads the use of the product to be interpreted as a cheaper habit when compared to other 
tobacco  and  related  products.  Indeed,  attempts  to  quit  consumption  of  this  product  were  rarely 
motivated by economic reasons.  

Respondents in the online survey were asked whether they thought that waterpipe tobacco might be 
particularly appealing to younger people. The figures below report that 72% of the 18-25 age group 
agreed as did 64% of the 26+ age group. 

Figure 23. Perceived appeal of waterpipe to youth (waterpipe; 18-25 age group)  

Percentage and number of current users in the 18-25 age group  

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.16. Do you think that young people might be particularly attracted to waterpipe (e.g. shisha 
& narghile) tobacco, or not? 
Source: OE elaboration from online survey data 

Figure 24. Perceived appeal of waterpipe to youth (waterpipe; 26+ age group)  
Percentage and number of current users in the 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.16. Do you think that young people might be particularly attracted to waterpipe (e.g. shisha 
& narghile) tobacco, or not? 
Source: OE elaboration from online survey data 

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Consumer preference and perception of specific categories of tobacco and related products 

Younger  participants  in  the  focus  group  (aged  20  to  30  y.o.)  characterised  waterpipes  as  an 
experimental and innovative product. They viewed it as a social ritual and believed that it was better 
than other tobacco and related products.  

“Young girls and young boys [from 15 to 25] who don’t smoke much” on those that 
are likely to experiment with waterpipe tobacco; (M, 32, ES) 

“I’ve noticed that, when I was 16 or 17, when I told my mother that I’m going to a 
shisha  bar  to  celebrate  a  birthday,  she  said  okay.  […]  It’s  more  tolerated  than 
smoking cigarettes.” (M, 24, DE) 

“A student, at 5 in the morning, dawn, the party is over, and they sit around, the 
last  ones  hang  out,  they  smoke  a  narghile”  on  the  perceived  ritual  of  waterpipe 
tobacco consumption; (M, 27, EL) 

“[Waterpipe smokers] are mostly young.” (M, 20, FR)  

Respondents  of  the  online  survey  were  also  concerned  for  the  younger  generations.  Seven  in  ten 
respondents in both age groups agreed that youth might underestimate the risk of using waterpipe 
tobacco and this belief was relatively equal across user types. 

Figure 25. Extent to which respondents believed that youth underestimate risks of using waterpipe 
tobacco (18-25 age group)  

Percentage and number of current users in the 18-25 age group  

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.17. Do you think that young people might underestimate the risk of using to waterpipe (e.g. 
shisha & narghile) tobacco, or not?  
Source: OE elaboration from online survey data 

55 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 26. Extent to which respondents believed that youth underestimate risks of using waterpipe 
tobacco (26+ age group) 

Percentage and number of current users in 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.17. Do you think that young people might underestimate the risk of using to waterpipe (e.g. 
shisha & narghile) tobacco, or not?  
Source: OE elaboration from online survey data 

While the previous tables evidenced concerns about the risk of waterpipe use, in the focus groups we 
heard a range of views. 

“For me the waterpipe recently has started to be considered harmful.” (M, 24, BG) 

“Ok, so what is most harmful is the shisha/narghile.” (M, 20, FR)  

“The IQOS and the waterpipe, as they work with heating, they are considered less 
harmful (than normal tobacco) although there are still not enough data.” (M, 25, 
BG) 

“Someone told me if you pull a smoke from the shisha it’s equivalent to one or two 
cigarettes. However, I would say it’s even worse than a cigarette [the waterpipe].” 
(M, 24, DE) 

Furthermore, apart from German respondents, the focus group participants did not regard waterpipe 
tobacco as addictive. 

The ‘swing methodology’ was used to assess the perceived harmfulness (risk perception) of the five 
tobacco  and  related  products,  plus  conventional  cigarettes.  As  described  in  the  section  1.3.3 
respondents were asked to choose the product that they thought was most damaging to the health of 
users. This product was given a score of 100 against which the other products were awarded scores 
between 0 – 100. the average scores for the other five products were computed (see Figure 23) in 
which the rank ordering of products runs from the ‘most damaging to health of users’ on the left hand 
side to the least damaging on the right hand side. 

Waterpipe tobacco was perceived as the least harmful product by the 18-25 age group (see Figure 
27),  with  an  average  score  of  53  out  of  100.  With  a  group  average  score  of  86  for  conventional 
cigarettes, waterpipe use carries about 35% less risk of damage to the health of users. It is notable 
that current users of waterpipes rate the health risk at 45. 

56 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Respondents in the 26+ age group also saw conventional cigarettes as most harmful with an average 
score of 82 (see Figure 28). The full sample scored waterpipes at 47 and current users at 41. While, 
the survey had found that respondents thought it likely that younger people might underestimate the 
risks of waterpipe use,  the swing method of assessing risk perception suggests that such  concerns 
should be extended to all users regardless of age. 

Figure 27. Perceived harmfulness of waterpipe tobacco to users (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.1.a.29 & Q.3.1.b. You have chosen (e.g. cigarettes, except slims30) as likely to be the most 
damaging to the health of users. We will give (e.g. cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g. cigarettes,  except slims),  you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
waterpipe tobacco user profiles, and therefore differs from the other chapter. The products are sorted in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

29 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
30 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

57 

 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 28. Perceived harmfulness of waterpipe to users (26+ age group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910)  
Question: Q.3.1.a.31 & Q.3.1.b. You have chosen (e.g. cigarettes, except slims32) as likely to be the most 
damaging to the health of users. We will give (e.g. cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g. cigarettes,  except slims),  you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
waterpipe tobacco user profiles, and therefore differs from the other chapter. The products are sorted in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

The focus group participants reported that they lacked information and/or read inconclusive research 
findings about the health impacts of waterpipe tobacco use. It was mentioned that consumers may 
not actually see the product warnings because the product issued in special premises. Yet, a modest 
share of respondents reported trying to stop or reduce consumption of waterpipe tobacco on account 
of  tobacco  health  warnings,  with  15%  and  18%  reporting  this  in  the  18-25  and  26+  age  group, 
respectively.33  

“There  isn’t  enough  research  on  both  of  them  yet  (e-cigarette  and  waterpipe 
tobacco).” (M, 22, DE) 

“I  don’t  think  […]  waterpipe  are  health  friendly,  I’m  sceptic  about  that.  I  think 
studies continue.” (F, 42, BG) 

31 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
32 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  
33 Note that the type of tobacco advertisement was not taken into account.  

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Consumer preference and perception of specific categories of tobacco and related products 

The perception of damage to the health of bystanders exposed to second-hand smoke from waterpipe 
tobacco was also examined in the online survey. In both age groups, respondents believed that the 
product was more harmful to bystanders than e-cigarettes, but less harmful than the other products. 
However, in the 18-25 age group (see Figure 29), current users believed it was just as harmful as e-
cigarettes  to  the  health  of  bystanders,  while  current  users  in  the  26+  age  group  (see  Figure  30) 
considered it to be the least harmful product, even less than e-cigarettes. Current users in the 26+ 
age group provided a low score of 38 out of 100 points in terms of harm to the passive user. There 
was an overall misperception on the harms of the product; focus group participants dissociated it from 
other tobacco products due to the difference in consumption pattern (i.e. smoked in social settings 
and less frequently). This factor could be in part reflected in their perception of harmfulness. 

Figure 29. Perceived harmfulness of waterpipe to bystanders (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.2.a.34 & Q.3.2.b. Q.3.2.b. You have chosen (e.g. cigarettes, except slims35) as likely to be 
the most damaging to the health of passive users. We will give (e.g. cigarettes, except slims) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g. cigarettes, except slims), you would give it 100 points 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for waterpipe tobacco user profiles, and therefore differs from the other chapter. The products 
are  sorted  in  descending  order  of  the  average  score  provided  by  the  “group  total,”  i.e.  amongst  all 
respondents of that age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

34 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
35 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 30. Perceived harmfulness of waterpipe to bystanders (26+group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.3.2.a.36 & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims37) as likely to be 
the most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims), you would give it 100 points 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for waterpipe tobacco user profiles, and therefore differs from the other chapter. The products 
are  sorted  in  descending  order  of  the  average  score  provided  by  the  “group  total,”  i.e.  amongst  all 
respondents of that age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

Finally,  in  terms  of  consumer  perception,  the  online  survey  findings  noted  a  general  tendency  to 
believe all tobacco and related products should be taxed equally in order not to favour any product in 
particular. Participants in the focus group were critical of the insufficiency information on the health 
effects of waterpipe tobacco and that such information was not readily available. The conviction that 
the product was inadequately regulated stemmed from the easy accessibility  for underage users in 
“shisha”  bars.  Participants  claimed  that  there  should  be  more  transparency  about  the  potential 
negative  effects  of  using  waterpipe  tobacco,  and  particularly  the  ingredients  in  contained.  They 
suggested that the launch of public campaigns similar to those on the consequences of conventional 
tobacco  the  establishment  of  “Consumer  Advice  Centre”  specialising in  waterpipe  tobacco  products 
could be effective ways to inform consumers.  

36 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
37 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

“Quality  standards  and  declaration.  All  ingredients  should  be  listed  and  the 
consequences as well. People should be made aware of the risks. I personally didn’t 
know when I started out. If people had more information on this then they might 
think twice.” (M, 30, DE)  

“I think it [waterpipe tobacco] is not regulated enough.” (M, 34, ES) 

Moreover, some people assumed that bars allowing indoor smoking of waterpipe products should be 
more  regulated  to  strengthen  the  restrictions  on  access  to  premises  offering  waterpipe  tobacco 
products.  

2.4  Health, social and economic impacts 

Despite the fact that waterpipe tobacco products have existed for a very long time, research on the 
effects of waterpipe tobacco on health are still limited. Investigations of waterpipe use must consider 
in detail the many variables associated with the product’s use, e.g. the type of equipment, the smoking 
patterns, and tobacco quality. Overall, most studies on health impacts agree on the fact that users of 
waterpipe tobacco products are exposed to many of the same toxic compounds and by-products as 
conventional cigarette users. A major source of tobacco addiction is nicotine – and the levels of nicotine 
in waterpipe tobacco are highly variable as they depend on the type of tobacco used. Neergaard et al. 
(2007) conducted a review of evidence on the exposure to nicotine stemming from waterpipe tobacco 
use. The reviewed smoking-machine studies indicated that the nicotine yield of a 45-minute session 
of waterpipe tobacco use (2.94 mg) greatly exceeded the nicotine yield from smoking a conventional 
cigarette  (0.88  mg).  This  finding  is  especially  concerning  that  users,  and  notably  younger  users, 
typically  perceive  waterpipe  consumption  as  less  harmful  than  other  tobacco  products  (see  section 
2.1  for  more  on  perceptions  of  impact  to  health  from  the  literature).  Another  well-known  harmful 
component of tobacco is tar. A single waterpipe tobacco session of 45 minutes reached levels of tar 
equal  to  802 mg,  representing  a  level  that  is  36.5  times  the  one  found  with  a  single  conventional 
cigarette use (Qasim, 2019). 

Waterpipe  tobacco  has  a  similar  toxicant/chemical  profile  to  conventional  cigarettes  but  at  much 
higher levels, which may produce detrimental impacts on the user (Qasim et al., 2019). According to 
the  WHO  (2015),  laboratory  analyses  of  waterpipe  smoke  have  revealed  measurable  levels  of 
carcinogens  as  well  as  toxicants  (e.g.  nitric  oxide).  In  addition,  the  burning  charcoal  was  found  to 
generate  high  levels  of  carbon  monoxide  (CO)  and  other  carcinogenic  substances.  Data  from 
biomarker  assays  have  measured  the  levels  of  toxicant  and  carcinogen  in  blood  and  urine  tests  of 
users and found that they were significantly exposed to these compounds (St Helen et al., 201438). As 
a result, waterpipe use may result in long-term adverse health outcomes, such as strokes, cancers 
(e.g.  lung,  oral,  gastric  and  oesophageal),  low  birth  weight  and  other  pregnancy  complications, 
periodontal  disease,  lung  disease,  cardiovascular  diseases,  chronic  obstructive  pulmonary  disease, 
and other medical conditions (Akl et al., 2011; Akl et al., 2016; Jawad, 2013; Kim, 2016; DKFZ, 2018, 
Germany).  

A  recent  study  on  dual  use  (Khan  et  al.,  2020)  found  that  waterpipe  tobacco  altered  several 
biomarkers in users and evidence of aggravated pulmonary and cardiovascular conditions in users of 
waterpipe tobacco and conventional cigarettes. In other words, dual use was found to be more harmful 
than exclusive use of one of the two products. A recent medical study also investigated biomarkers of 
toxicants  associated  with  waterpipe  use  and  passive  waterpipe  exposure  among  employees  at 
waterpipe  venues  (Kaplan  et  al.,  2019).  Waterpipe  tobacco  users  and  non-smoking  employees  at 
waterpipe  venues  were  found  to  have  higher  urinary  concentrations  of  several  toxic  metals  (e.g. 

38 As reported in the WHO (2015) Factsheet.  

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Consumer preference and perception of specific categories of tobacco and related products 

manganese and cobalt) and were therefore likely to be at an increased risk of health problems due to 
first-hand or second-hand exposure alike.  

At the time of the discussions surrounding the 2014 TPD revision, certain niche tobacco products could 
be granted an exemption from certain labelling requirements (i.e. cigars). It was established that the 
full regime should be applied to waterpipe tobacco products in order to fight the misconceptions of 
the  product  being  less  harmful  than  other  tobacco  and  related  products.39  Ali  &  Jawad  (2017) 
suggested  that  health  warning  messages  should  focus  on  health  outcomes  specific  to  waterpipe 
tobacco, e.g. the potential for CO poisoning and the risk of infection transmission when sharing the 
waterpipe. In line with this, Arshad et al. (2019) concluded that interventions and policy measures to 
portray  a  message  of  increased  harm  of  waterpipe  tobacco  use  amongst  students  are  required.  In 
general, students were  quite dismissive of policies employed to  reduce waterpipe use, stating they 
had  no  access  to  public  health  campaigns  or  that  current  public  health  campaigns  surrounding 
waterpipe tobacco use were not very good.40 Social media was also flagged as a channel for waterpipe 
tobacco advertising and promotion (Jackler, 2019, USA; Ali & Jawad, 2017). Social media may have 
a role to play in directly addressing social norms towards waterpipe tobacco to combat the positive 
normative  perception  that  has  been  observed  online.  Indeed,  from  a  random  sample  of  5,000 
waterpipe-related tweets in 2014, 87% were deemed to normalise waterpipe tobacco use by making 
it seem common, normal to use, and portraying it positively (Krauss et al., 2015). 

With  respect  to  economic  impacts,  the  waterpipe  tobacco  consumed  on  the  EU  market  is 
overwhelmingly  manufactured  outside  of  the  EU  –  with  very  limited  manufacturing  reported  in 
Germany and Poland (EC, 2017).  In the EU the product is mainly smoked in  ‘shisha lounges’, with 
approximately 80% of overall use occurring in lounges and 20% bought for private consumption online 
or from retailers (EC, 2017; Ebrahimi Kalan et al, 2020). There were an estimated 8,000 lounges in 
Germany, about 8,000 in France, and some 3,000 in the UK in 2017 (EC, 2017). Currently, waterpipe 
tobacco  falls  under  the  “other  tobacco  product”  category  in  the  Tobacco  Excise  Directive  and  the 
structure for taxing this category is different than for cigarettes. Member States can choose between 
applying a specific component, an ad valorem  component or a mixture of the two. As a  result, tax 
rates applied to waterpipe tobacco  varied greatly across EU Member States as  of 2017 (see Figure 
175). As noted in section 2.1, this may encourage cross-border selling as well as the consumption of 
the product in some Member States that sell the product for cheaper than tobacco alternatives (EC, 
2020).  The  flexibility  granted  to  Member  States  for  the  taxation  under  the  other  smoking  tobacco 
category may divert  efforts to reduce tobacco  consumption by almost incentivising youth to switch 
from conventional cigarettes to waterpipe tobacco. However, a majority of MS did not consider that 
the issue with waterpipe tobacco was of sufficient severity to justify the establishment of a separate 
tax category and were not ready to bear the related adaptation costs (EC, 2017). 

Jawad (2014, global) studied global tobacco control policies prior to the implementation of the TPD. 
After  reviewing  the  legislation  of  62  countries,  he  found  that  most  regulations  did  not  address 
waterpipe smoking explicitly. The review concluded that, based on harmful exposure alone, there was 
sufficient justification to commence health awareness campaigns and incorporate waterpipe products 
into  existing  tobacco  control  efforts  in  the  UK.  The  TPD  was  implemented  in  2014,  and  precisely 
addressed these issues. Jawad et al. (2015) analysed the impact of waterpipe tobacco pack  health 
warning labels among regular users in London. They found that perceptions of harmfulness stemming 
from  health  warnings  on  waterpipe  tobacco  packs  were  “dose-responsive”.  In  other  words,  the 
response  became  more  negative  as  the  health  warning  increased  in  size.  The  evidence  argues  in 
support  of  the  need  for  warning  labels  on  waterpipe  tobacco  products,  as  well  as  associated 

39 https://ec.europa.eu/taxation_customs/sites/taxation/files/study_on_directive-2011_64_main_text_en.pdf 
40 This is notably from studies conducted in the United Kingdom.  

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Consumer preference and perception of specific categories of tobacco and related products 

accessories and waterpipe-serving premises (Jawad, 2016). Most social users of the product report 
an overall lack of exposure to health warnings on waterpipe tobacco packs due to the inherent nature 
of waterpipe smoking, that is, smoking in a café with the apparatus already prepacked by staff. Health 
warnings at the point of consumption had reportedly more impact than health warnings at the point 
of sale (Jawad et al., 2015). 

2.5   Concluding remarks on waterpipe tobacco 

This section summarises the main findings that emerged from the research conducted on waterpipe 
tobacco products. The systematic review revealed that: 

  Waterpipe users are exposed to toxicants from both the tobacco and the charcoal used to heat 
it.  Toxicant  yield  studies  have  consistently  found  substantial  levels  of  tar,  nicotine,  CO  and 
cancer-causing  chemicals  in  waterpipe  tobacco  smoke.  Emerging  evidence  suggests  that 
waterpipe tobacco has harmful long term effects on health, similar to those of other forms of 
smoked tobacco. Growing evidence shows the risk of second-hand waterpipe tobacco smoke, 
particularly in waterpipe cafes, where the product is mainly smoked. 

  As found in the Eurobarometer 458 (2017), the prevalence of waterpipe tobacco current use in 
the EU was negligible among adults but it was 2% in the 15-24 age group. However, in this 
same group, the lifetime prevalence was 28%, while in the overall population it was 13%. It is 
difficult to estimate the total sales of waterpipe tobacco because the  available data reviewed 
merges  waterpipe  and  pipe  tobacco.  However,  according  to  the  Eurobarometer  458  (2017), 
the highest lifetime prevalence of use was in Nordic and Baltic countries of the EU. There is 
very limited manufacturing in the EU, with some reported in Germany and Poland.  

  Currently, waterpipe tobacco falls under the “other tobacco product” category in the Tobacco 
Excise Directive (TED) and the structure for taxing this category is slightly different than for 
cigarettes. MS can choose between applying a specific component, an ad valorem component 
or  a  mixture  of  the  two.  As  a  result,  tax  rates  applied  to  waterpipe  tobacco  varied  greatly 
across EU Member States as of 2017. 

  Most  social  users  of  the  product  report  an  overall  lack  of  exposure  to  health  warnings  on 
waterpipe  tobacco  packs  due  to  smoking  in  social  settings  where  the  products  are  already 
unpacked by staff. Health warnings at the point of consumption had reportedly more impact 
than health warnings at the point of sale. 

The empirical work (focus groups and online survey) revealed the following user profile: 

  Respondents  in  the  18-25  age  group  were  flagged  as  an  important  consumer  group  for 
waterpipe tobacco, with the majority (53%) in the Member States included in this study having 
at least tried the product. 

  The profile of the current waterpipe users is characterised by the variability of frequency (at 
least once  a month) and duration of use (5-60 minutes per session). Younger users started 
using as minors, while older users  started as adults, which opens the  question if the age of 
initiation is rapidly changing. A great majority of users started consuming waterpipe tobacco 
for enjoyment. However, socialising is another frequently mentioned reason. At least 8 in 10 
current waterpipe users were or are using other tobacco and related products concurrently.  

  Current waterpipe users were  evenly split between those that had never attempted quitting 
use of the product and those who tried at least once and failed in the 18-25 group. In the 26+ 
age group, almost 2 in 3 had never tried to quit. Among failed quitters, the main reason to 
attempt to quit was for personal health. A distant second reason was  to quit in response to 

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Consumer preference and perception of specific categories of tobacco and related products 

tobacco control measures - either existing restrictions to smoke at work or home in the 18-25 
age group or due to health warnings on packages in the 26+ age group.  

  The profile of the past waterpipe users is typified by the variability of frequency (from daily to 
at least once a month) and duration of use (5-60 minutes per session).). The great majority 
of past users were dual users of tobacco products. However, their evolution seems to split the 
group  into  those  who  quit  all  tobacco  products  and  those  who  progress  to  other  tobacco 
products. About 1 in 2 of past waterpipe users in the 18-25 group and 1 in 3 in the 26+ group, 
were abstaining completely from using any tobacco and related product. By contrast, about 1 
in 3 former waterpipe tobacco users in the 18-25 group and 1 in 2 in the 26+ group were now 
using other tobacco and related products. 

Lastly, the following paragraphs highlight the Product and Regulatory perceptions remarks 

  Perception  of  marketing  practices.  Consumption  of  waterpipe  tobacco  was  perceived  as  an 
emerging  novel  product,  especially  among  younger  generations,  as  well  as  a  timeless  and 
classic product due to its long presence on the market and in certain ethnic groups in Europe. 
It  evoked  the  idea  of  “zen,”  “pleasure,”  and  “relaxation”.  The  more  negative  terms  (e.g. 
‘complicated’,  ‘unhealthy’  and  ‘addictive’  were  mainly  cited  by  never  users.  In  the  26+  age 
group, 39% of respondents characterised the product as  ‘unhealthy’ as the most often cited 
term.  In  the  18-25  age  group,  the  term  associated  most  often  with  waterpipe  tobacco  was 
“nice flavours”.  

  Between 2 in 3 and 3 in 4 respondents, depending on age, believed that smoking waterpipe 
tobacco would be particularly appealing to youth. The flavours, social ritual (i.e. rarely used 
alone),  perceived  affordability,  lower  risk  perception  than  other  tobacco  products  were  the 
main  elements  driving  the  appeal  of  waterpipe  tobacco  products  according  to  focus  group 
participants. 

  Perception of risk. Waterpipe tobacco was perceived as the least harmful product to users and 
the second least harmful to bystanders (after e-cigarettes) of the studied products. It was also 
perceived as less addictive. The reduced perception of harmfulness of waterpipe might be partly 
related to the difference in consumption pattern with respect to other tobacco products, i.e. 
smoked in social settings and less frequently. The behavioural intent of waterpipe tobacco use 
may  be  shaped  by  social  pressures  and  through  social  media,  where  both  advertising  and 
promotion occurs.  

  Regulatory support. There was a perception that the product was hardly regulated. It stemmed 
from the easy accessibility for underage users in “shisha” bars. There was a general tendency 
to believe all tobacco and related products should be taxed equally in order not to favour any 
product.  Participants  of  the  focus  groups  criticised  the  insufficient  and  not  easily  available 
information regarding health effects of waterpipe tobacco. It was mentioned that consumers 
may  not  actually  see  the  product  warnings  because  the  product  is  mainly  used  in  special 
premises where the product is served unpacked. 

64 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

3  Slim cigarettes  

3.1  Background 

Slim cigarettes are one of the oldest products on the EU market among those within the scope of the 
study. They were historically marketed with the positive connotations of femininity and elegance as 
the tobacco companies tried to attract new consumer groups, namely young women. Since 2000, the 
market share of slim cigarettes has grown significantly in an overall declining EU cigarette market. 41 
In December 2012, the EU Commission proposed a ban on the sale of flavoured and slim cigarettes 
across  the  EU  through  a  revision  of  the  Tobacco  Products  Directive.  However,  following  resistance 
from some Member States the ban was dropped in final draft and statement was made that market 
developments and perceptions of the product should be monitored.  

Market development. The figure below represents the structure of the EU market of slim cigarettes 
in absolute values (million units) by country for 2017.42 The largest markets in terms of retail volume 
of  slim  cigarettes  were  Poland,  Italy,  Bulgaria, Romania,  Greece  and  Czech  Republic  –  the  product 
was especially popular in Eastern Europe. 

Figure 31. Market size of slim cigarettes in million units in 2017 

Note: The market size is estimated total sales in million units for 2017, without population adjustments. 
Note that this is different than other products as the information in million euros was not available for this 
product. It is displayed as a tree map graph that consists of series of nested rectangles of sizes proportional 
to the corresponding data value. 
Source: OE elaboration from Passport, 2017 

41 Slim cigarette fact sheet. https://ec.europa.eu/health/sites/health/files/tobacco/docs/fs_slim_cigarettes_en.pdf 
42 Data on slim cigarettes data was available for the market size in million units, but not in retail selling price (RSP).  

65 

PLITBGROELCZFRHUDELTSESKLVHRPTATUKSINDE 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

The map below provides a visual representation of the share of slim cigarettes by national tobacco 
markets  across  the  EU.43  Among  the  Member  States,  the  consumption  of  slim  cigarettes  was 
particularly high in Bulgaria in 2017, representing a share  of almost two fifth of the  entire tobacco 
market, followed by Poland (close to 32%), and Latvia and Lithuania with close to one fifth.  

Figure 32. Share of slim cigarettes within the national total tobacco market, per country (2017) 

Note: Share of slim cigarettes were estimated with respect to the whole tobacco market in the country in 
million euros. 
Source: OE Elaboration from Passport, 2017  

The data showed that the market development trend in the slim cigarettes varied greatly across the 
EU (see Figure 33.). In the past years, retail volume of slim cigarettes market increased significantly 
in Lithuania, Latvia, the UK, France, Bulgaria and Sweden. It also decreased in several Member States, 
notably Germany and Portugal, but by a much smaller magnitude. 

Figure 33. Market size growth of slim cigarettes, in retail volume in 2017 as a baseline of 2012 

Note:  EU  average  is  calculated  for  25  EU  MS  (excluding  Cyprus,  Luxembourg  &  Malta  -  no  data  were 
available). The figure  looks  at the market growth in retail volume of slim cigarettes between 2012 and 
2017. 

43 In this case, the figure is based on the share of slim cigarettes available in terms of real retail volume and calculated the 
share in RSP values with respect to the whole tobacco market. 

66 

-30-101030507090110130ATBEBGCYCZDEDKEEELESFIFRHRHUIEITLTLULVMTNLPLPTROSESISKUKEU 
 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Source: OE elaboration of Passport, 2017 

The  dynamics  of  historical  data  are  illustrated  in  Figure  34.  Most  countries  saw  an  increase  in  the 
share  of  slim  cigarettes  on  the  cigarette  market  over  the  past  years.  In  Bulgaria  and  Poland,  the 
increase and the share of slim cigarettes were highest, with 38% and 33% respectively, in 2017. Slim 
cigarettes were also in high demand in Latvia, Lithuania, Hungary, Greece and Romania. 

Figure 34. Share of slim cigarettes in total market of cigarettes, in retail volume: 2012-2017 

Note: EU average is calculated for 25 EU members (excluding Cyprus, Luxembourg and Malta - no data 
were available). The dynamics of time series data was constructed from the share of the slim cigarettes in 
the market of all types of cigarettes (i.e. not in terms of the whole tobacco market, as above). 
Source: OE elaboration from Passport, 2017 

Several studies have found that there was a greater prevalence of slim cigarette use among female 
smokers (Milcarz et al., 2017, Poland). While there is limited data available from EU studies, Canadian 
studies show that tobacco companies increasingly targeted females and young people through slim 
cigarette design features and packaging (Minaker, 201744). However, while the rate of slim cigarette 
use was higher for females than males among school grades 9–12 smokers, the difference was not 
statistically significant. In line with these results, Slater (2016, global) found no evidence for greater 
slim cigarette smoking by females. 

44 The study was based on secondary data from the Youth Smoking Survey 2008/2009 (N=29,296); Youth Smoking Survey 
2010/2011  (N=31,396);  Youth  Smoking  Survey  2012/2013  (N=27,404);  and  the  Cancer  Risk  Assessment  in  Youth  Survey 
2015 (N=12,110). 

67 

051015202530354045ATBEBGCYCZDEDKEEELESFIFRHRHUIEITLTLULVMTNLPLPTROSESISKUKEU201220152017 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Consumer perceptions. The marketing of slim cigarette towards women began in the 1990s to resist 
the  ‘good  girl’  image  and  to  be  part  of  the  transition  from  childhood  into  adulthood.  The  tobacco 
industry  made  slim  cigarettes  a  symbol  of  gender  equality,  sophistication  and  upward  mobility. 
Smoking was made to look fun, glamorous, healthy, liberating, relaxing, sexually attractive, slimming 
and  sophisticated.  Coloured  packs  were  also  developed  to  attract  children  (European  Institute  of 
Women’s Health45). The image propagated by the industry is still relevant. Young people have been 
shown to associate slim cigarettes with femininity and elegance (Moodie et al., 2015).  

The Eurobarometer 458 highlighted the positive perception of slim cigarettes especially in the Czech 
Republic  (46%),  Belgium  (42%),  Slovenia  (41%)  and  Greece  (39%).  18%  of  all  EU  potential 
consumers  perceiving  the  product  as  attractive,  feminine  and  elegant  in  2017  (see  Table  28), 
suggesting that part of their attraction is aesthetic.46 7% agreed that slim cigarettes ‘are less harmful 
than  normal  cigarettes’,  with  Member  States  varying  in  the  level  of  agreement  from  2%  to  17%. 
Research has reported  that the industry misled consumers by giving a false impression  of reduced 
harm from slim cigarettes in comparison to conventional cigarettes (Mutti, 2011, Canada, US and UK, 
N=6,075). However, there was no evidence for this claim (Mladjenovic, 2012, Canada). That people 
perceived slim cigarettes as less harmful than traditional cigarettes motivated discussions on a ban of 
the product in the European Union in 2013 (Braun et al., 2019).  

Moodie (2015, UK) studied the perceptions of slim cigarettes, using focus groups with female non-
smokers and tobacco users aged 12 to 24 years. Participants ranked different types of cigarettes (slim, 
coloured, aromatised and capsule) on the criteria of appeal, taste and harm. Slim cigarettes generated 
significant interest among participants and were perceived as some of the most appealing, pleasant 
tasting and least harmful products. In similar vein, Gallopel-Morvan (2018, France, N=998) found that 
15 to 30 year old tobacco smokers and non-smokers viewed slim cigarettes as less harmful as well as 
more appealing than conventional cigarettes. 

45 https://eurohealth.ie/wp-content/uploads/2013/05/SmokingPBFIN.pdf 
46 GTSS data cover small cigarillos, e-cigarettes and waterpipe products. Unfortunately, the data are limited and only available 
for three countries (Greece, Poland and Romania). 

68 

 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Table 24. “Which of the following statements, if any, do you think apply to slim cigarettes?” (2017) 

e
s
o

l

u
o
y

l

p
e
h

y
e
h
T

)

%

(

t
h
g
e
w

i

e
v
i
t
c
a
r
t
t
a

e
r
a

y
e
h
T

i

,
e
n
n
m
e
f

i

.
g
.
e
(

)

%

(

)
t
n
a
g
e
e

l

EU28 

AT 

BE 

BG 

CY 

CZ 

DE 

DK 

EE 

EL 

ES 

FI 

FR 

HR 

HU 

IE 

IT 

LT 

LU 

LV 

MT 

NL 

PL 

PT 

RO 

SE 

SI 

SK 

UK 

1 

3 

7 

1 

2 

1 

0 

2 

1 

0 

0 

1 

1 

1 

3 

2 

2 

2 

2 

1 

2 

1 

2 

2 

2 

1 

1 

2 

1 

18 

19 

42 

33 

22 

46 

6 

22 

30 

39 

8 

10 

27 

32 

32 

12 

22 

31 

27 

30 

14 

12 

21 

15 

18 

13 

41 

29 

6 

)

%

(

s
e
t
t
e
r
a
g
i
c

o
t

r
e
i
s
a
e

e
r
a

y
e
h
T

l

a
m
r
o
n

n
a
h
t

e
k
o
m
s

6 

9 

17 

10 

8 

14 

2 

5 

5 

16 

3 

3 

4 

8 

11 

7 

10 

12 

3 

10 

3 

8 

7 

5 

14 

6 

4 

12 

2 

l

a
m
r
o
n

n
a
h
t

l

u
f
m
r
a
h

7 

s
s
e

l

e
r
a

y
e
h
T

)

%

(

s
e
t
t
e
r
a
g
i
c

10 

15 

7 

4 

8 

2 

2 

3 

8 

2 

5 

4 

8 

11 

8 

16 

6 

7 

7 

4 

14 

9 

7 

10 

6 

6 

10 

2 

)

%

(

e
n
o
N

47 

41 

15 

30 

31 

22 

67 

39 

38 

36 

57 

56 

42 

36 

33 

41 

36 

45 

45 

43 

48 

26 

38 

38 

37 

33 

44 

25 

67 

)

%

(
w
o
n
k

t
o
n

o
D

25 

23 

12 

27 

37 

18 

25 

29 

26 

11 

29 

26 

25 

20 

17 

31 

19 

12 

20 

14 

31 

41 

27 

35 

25 

45 

8 

27 

23 

Base: all respondents of Eurobarometer 458 (representative sample of EU), N=27,901 
Note:  Each  row  represents  a  different  country  and  provides  the  proportion  of  respondents  within  that 
country that selected the response option. Note that multiple answers were allowed. The table was based 
on QB.8 of the Eurobarometer survey.  
Source: Eurobarometer 458, 2017  

69 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Impacts. Braun et al. (2019) assessed the exposure risk of particulate matter to passive smokers for 
super-slim size cigarettes compared to a king size brand. They concluded that the particulate matter 
pollution generated by slim-size tobacco products were substantial and sometimes higher than those 
produced by king size tobacco products. 

An  analysis  of  Vogue  cigarettes  found  no  significant  difference  in  the  content  of  tar  of  the  classic 
cigarette  sizes  (KSC47 Vogue  La  Cigarette)  and  slim  cigarettes  (SSL48  Vogue  BLEUE).  The  nicotine 
content of slim cigarettes (0.60 mg) was higher than the standard size (0.40 mg), but this difference 
was not found to be significant. The analysis revealed that slim cigarette particular matter (PM) levels 
were higher than in conventional cigarettes. It was concluded that the smaller-sized cigarettes were 
potentially more harmful to smokers and passive smokers (Kant et al., 2016). 

3.2  Market developments  

3.2.1 Socio-demographic characteristics  

The  online  survey  showed  current  usage  of  slim  cigarettes  at  11%  for  the  18-25 age group (see 
Figure 35) and 12% for the 26+ age group (see Figure 36). Bulgaria and Poland had high prevalence 
of slim cigarette users in both age groups. In the 18-25 age group, 23% of respondents reported 
current  use  of  slim  cigarettes  in  Bulgaria,  with  only  35%  of  never  users.  By  contrast,  75%  of 
respondents in Germany had never tried the product (i.e. never users).  In the  26+  age group, a 
majority  had  never  tried  slim  cigarettes,  but  this  varied  significantly  across  the  countries  studied, 
ranging from the 35% to 75% of never users.  

Figure 35. Use of slim cigarettes: country breakdown (18-25 age group) 

Percentage of all respondents in the 18-25 age group 

Base: all respondents in the 18-25 age group (N=6,090) 
Question: Q.1.1. Have you ever used slim cigarettes? 
Note: The group total category refers to all respondents within the age group. 
Source: OE elaboration from online survey data 

47 King Size Cigarette 
48 Super Slim Size 

70 

 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 36. Use of slim cigarettes: country breakdown (26+ age group) 

Percentage of all respondents in the 26+ age group 

Base: all respondents in the 26+ age group (N=5,910) 
Question: Q.1.1. Have you ever used slim cigarettes? 
Note: The group total category refers to all respondents within the age group.  
Source: OE elaboration from online survey data 

71 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 25 and Table 26 report the socio-demographic profiles of current, past, occasional and never 
users of slim cigarettes. In the 18-25 age group, current users were marginally more likely to be 
female,  with  lower  education,  living  in  urban  settings  and  with  self-reported  high  socio-economic 
status. In the 26+ age group more females (15%) than males (10%) were current smokers. Higher 
education,  from  urban  settings  and  high  socio-economic  status  were  also  characteristics  of  current 
smokers. In both age groups slim cigarettes had low penetration in rural areas. 

Table 25. Slim cigarette use socio-demographic breakdown (18-25 age group) 

Percentage and number of all respondents in the 18-25 age group  

Group total  
% (n) 

Current users 
% 

Past users  
% 

Used once or twice  
% 

Never users  
% 

Use of product 

100 

11 

13 

20 

56 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

(6090) 

47 

(2869) 

53 

(3221) 

5 

(335) 

63 

(3829) 

32 

(1926) 

65 

(3949) 

19 

(1173) 

16 

(968) 

10 

12 

14 

10 

11 

12 

9 

7 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

18 

(1126) 

65 

(3954) 

17 

(1010) 

10 

10 

15 

11 

15 

10 

12 

16 

14 

11 

11 

12 

13 

15 

20 

21 

22 

21 

19 

22 

19 

16 

20 

21 

17 

59 

53 

54 

57 

54 

52 

61 

66 

58 

56 

53 

Base: all respondents in the 18-25 age group (N=6,090) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

72 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 26. Slim cigarette use socio-demographic breakdown (26+ age group) 

Percentage of all respondents in the 26+ age group 

Group total 
% (n) 

Current users  
% 

Past users 
% 

Used once or twice  
% 

Never users 
% 

12 

15 

19 

54 

Use of product 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

100 

(5910) 

52 

(3074) 

48 

(2836) 

5 

(308) 

46 

3-4 (medium) 

(2704) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

49 

(2898) 

66 

(3879) 

17 

(1010) 

17 

(1021) 

10 

15 

10 

11 

14 

15 

9 

6 

Self-reported socio-economic status 

1-4 (low) 

23 

(1374) 

64 

5-7 (medium) 

(3769) 

8-10 (high) 

13 

(767) 

10 

12 

19 

13 

16 

7 

13 

17 

17 

11 

8 

13 

15 

17 

21 

18 

15 

19 

20 

21 

17 

16 

17 

20 

19 

56 

51 

68 

58 

49 

47 

63 

69 

59 

54 

46 

Base: all respondents in the 26+ age group (N=5,910) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

73 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

3.2.2 Pattern of use  

Among  current  users  of  slim  cigarettes  in  the  18-25  age  group,  59%  smoked  them  daily  and  an 
additional  29%  smoked  them  about  once  a  week.  Similar  percentages  were  found  in  the  26+  age 
group, at 55% and 30% respectively (see Figure 37 and Figure 38).  

Figure 37. Frequency of use of current slim cigarette users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of slim cigarettes in the 18-25 age group (N=656) 
Question: Q.1.3. How often do you use slim cigarettes? 
Source: OE elaboration from online survey data 

Figure 38. Frequency of use of current slim cigarette users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of slim cigarettes in the 26+ age group (N=802) 
Question: Q.1.3. How often do you use slim cigarettes? 
Source: OE elaboration from online survey data 

74 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Past slim cigarette users in the 18-25 age group reported smoking less frequently. 42% had used 
the product daily and 35% weekly. In the 26+ age group, 51% had smoked the product daily and 
29% weekly. Past users in the 26+ age group were much more regular users than the younger age 
group (see Figure 39 and Figure 40).  

Figure 39. Frequency of use of past slim cigarette users (18-25 age group) 

Percentage and number of past users in the 18-25 age group  

Base: past users of slim cigarettes in the 18-25 age group (N=536) 
Question: Q.1.6. How often did you use slim cigarettes? 
Source: OE elaboration from online survey data 

Figure 40. Frequency of use of past slim cigarette users (26+ age group) 

Percentage and number of past users in the 26+ age group 

Base: past users of slim cigarettes in the 26+ age group (N=864) 
Question: Q.1.6. How often did you use slim cigarettes? 
Source: OE elaboration from online survey data 

75 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure  41  and  Figure  42  report  intensity  of  use  –  how  many  sticks  used  on  days  when  they  had 
smoked. Current users in the 26+ age group reported being more intense use of slim cigarettes than 
the  18-25  age  group.  53%  of  respondents  in  the  18-25  age  group  reported  smoking  1  to  5  slim 
cigarettes per day of use, against 47% in the 26+ age group. In both age groups, close to one in four 
current users smoked over 10 slim cigarettes per day of use. Daily smokers also revealed that they 
had a more intensive pattern of use, especially in the 26+ age group (see Figure 186. and Figure 187. 
in  Annex).  For  example,  36%  of  daily  users  reported  smoking  over  10  cigarettes  per  day  of  use, 
compared to 26% in the overall current users’ sub-group.  

Figure 41. Average number of slim cigarettes per day of use (18-25 age group) 
Percentage and number of current users in the 18-25 age group  

Base: current users of slim cigarettes in the 18-25 age group (N=656) 
Question: Q.1.4.a. On the days that you use slim cigarettes, about how much do you use? 
Source: OE elaboration from online survey data 

Figure 42 Average number of slim cigarettes per day of use (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of slim cigarettes in the 26+ age group (N=725) 
Question: Q.1.4.a. On the days that you use slim cigarettes, about how much do you use? 
Source: OE elaboration from online survey data 

76 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Respondents under the age of 23 at the time of the study were on average likely to have started as a 
minor. Several respondents between the ages of 23 and 33 also began prior to turning 18 years of 
age. While the majority of respondents between 34 and 60 did not, several respondents over the age 
of 60 reported having started before turning 18.  

Figure 43. Initiation of use for current and past users (slim cigarettes; total sample) 

(number of current and past users in the overall sample) 

Base: current and past users of slim cigarettes in the total sample (N=2,93349) 
Question: Q.1.2.a. At about what age did you start using the products below? & Q.5.2. Age 
Note: The figure illustrates the approximate starting age of slim cigarette use among all respondents of 
the online survey, where the x-axis represents the current age of the respondent (Q.5.2) and the y-axis is 
the average numbers of years of product consumption (calculated by subtracting the current age from the 
starting age). The orange line represents the 45º or 18 y.o. line. Each blue point represents the average 
starting age for respondents of that age; points above the 18 y.o. line reveal those initiating consumption 
of slim cigarettes before the age of 18, while those below the line reveal age brackets starting consumption 
after the age of 18 on average. The blue lines represent the mean standard deviation, i.e. it does not show 
the full range of values for each age.  
Source: OE elaboration from online survey data 

49 NA and misreported values are excluded. 

77 

18 y.o. line  
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Past users in the 18-25 age group had consumed slim cigarettes for 3 years on average; the average 
for those in the 26+ age group was 9 years (see Figure 44 and Figure 45)  

Figure 44. Duration of use of past slim cigarette users (18-25 age group) 

Number of past users in the 18-25 age group 

Base: past users of slim cigarettes in the 18-25 age group (N=50350) 
Question: Q.1.2.a. At about what age did you start using slim cigarettes? & Q.1.2.b. At about what age 
did you stop using slim cigarettes? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was a past 
user of the product. The mean shows the average duration of use.  
Source: OE elaboration from online survey data 

Figure 45. Duration of use of past slim cigarette users (26+ age group) 

Number of past users in the 26+ age group 

Base: past users of slim cigarettes in the 26+ age group (N=80451) 
Question: Q.1.2.a. At about what age did you start using slim cigarettes? & Q.1.2.b. At about what age 
did you stop using slim cigarettes? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was a past 
user of the product. The mean shows the average duration of use.  
Source: OE elaboration from online survey data 

50 NA and misreported values are excluded. 
51 NA and misreported values are excluded. 

78 

 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 46 and Figure 47 report the reasons why people started to smoke slim cigarettes. In the 18-
25 age group, 45% of users said it was for enjoyment, 26% to socialise or because it was trendy and 
21% because everyone else was smoking. A similar pattern was observed in the 26+ age group, with 
47%, 28% and 16% respectively. In both age groups about one in five said it was to quit or to reduce 
consumption of other tobacco products.  

Figure 46. Reasons for initiation of slim cigarette use (18-25 age group) 

Percentage and number of current and past users in the 18-25 age group) 

Base: current and past users of slim cigarettes in the 18-25 age group (N=1,458)  
Question: Q.2.1.a. Why did you start using slim cigarettes? Please select up to 2 options. 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The percentages do not add up to 100% because respondents could select more than one term. For the 
response options including “smoking”, the type of product ‘smoked’ was not specified. 
Source: OE elaboration from online survey data 

Figure 47. Reasons for initiation of slim cigarette use ( 26+ age group) 

Percentage and number of current & past users in 26+ age group 

Base: current and past users of slim cigarettes in the 26+ age group (N=1,589)  
Question: Q.2.1.a. Why did you start using slim cigarettes? Please select up to 2 options. 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The percentages do not add up to 100% because respondents could select more than one term. For the 
response options including “smoking”, the type of product ‘smoked’ was not specified. 
Source: OE elaboration from online survey data 

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 48 and Figure 49 report on the reasons for starting to smoke slim cigarettes among those who 
had tried them ‘once or twice’. Enjoyment, socialising and trendy were the main reasons for both age 
groups. It is of note that, in the 26+ age group, tobacco advertisements were the third most cited 
reason (16%). The advertisements must have been very memorable given the regulations restricting 
tobacco advertising and sponsorships in Directive 2003/33/EC. 

Figure 48. Initiation of slim cigarette use: reasons for trying (18-25 age group) 

Percentage and number of those who tried once or twice in the 18-25 age group 

Base: those who tried to use slim cigarettes in the 18-25 age group (N=1,234)  
Question: Q.2.1.b. Why did you try slim cigarettes? Please select up to 2 options. 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The percentages do not add up to 100% because of the fact that respondents could select more than one 
term – therefore, the bars must be interpreted separately. For the response options including “smoking”, 
the type of product ‘smoked’ was not specified. 
Source: OE elaboration from study survey data 

Figure 49. Initiation of slim cigarette use: reasons for trying (26+ age group) 

Percentage and number of those who tried once or twice in the 26+ age group) 

Base: those who tried to use slim cigarettes once or twice in the 26+ age group (N=1,138)  
Question: Q.2.1.b. Why did you try slim cigarettes? Please select up to 2 options. 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The percentages do not add up to 100% because of the fact that respondents could select more than one 
term – therefore, the bars must be interpreted separately. For the response options including “smoking”, 
the type of product ‘smoked’ was not specified. 
Source: OE elaboration from online survey data 

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 50 and Figure 51 chart the reasons for attempting to quit slim cigarette smoking. In the 18-25 
age  group,  68%  of  current  slim  cigarette  smokers  reported  having  tried  to  quit  at  least  once  (see 
Figure 188 in Annex). The most cited reason for attempts to quit were personal health (29%), followed 
by price (economic reasons) (22%). In the 26+ age group, 71% of current users had attempted to 
quit, and 30% having tried to quit more than twice  (see Figure 189 in Annex). Their reasons were 
much the same as the younger age group: 35% for health and 21% on account of price. As with the 
younger age group, health warning messages on the packages were the least cited reason.  

Figure 50. Reasons for trying to quit slim cigarette use (18-25 age group) 

Percentage and number of current users in the 18-25 age group who tried to quit 

Base: current users of slim cigarettes that tried to quit in the 18-25 age group (N=445)  
Question: Q.2.2. What made you try to quit slim cigarettes? Select the most fitting answer. 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

Figure 51. Reasons for trying to quit slim cigarette use (26+ age group) 

 Percentage and number of current users in the 26+ age group who tried to quit 

Base: current users of slim cigarettes that tried to quit in the 26+ age group (N=512)  
Question: Q.2.2. What made you try to quit slim cigarettes? Select the most fitting answer. 
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 52 and Figure 53 report the reasons for starting to smoke slim cigarettes again after trying to 
quit.  The  reasons  were  both  personal  and  social.  The  18-25  age  group  cited  ‘stress’  (35%), 
‘temptation’ (26%) and it was ‘too difficult’ (24%). Almost one in five cited their ‘social environment’. 
A similar pattern was  evident 26+ age group;  ‘stress’ (32%),  ‘too difficult’ (31%) and ‘temptation’ 
(24%).  It  appeared  that  for  both  age  groups  addiction  made  quitting  an  almost  unsurmountable 
challenge. 

Figure 52. Reasons for starting to use slim cigarettes again (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of slim cigarettes that tried to quit in the 18-25 age group (N=445)  
Question: Q.2.3. Why did you start to use slim cigarettes again? Please select up to 2 options.  
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The percentages do not add up to 100% because of the fact that respondents could select more than one 
term – therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

Figure 53. Reasons for starting to use slim cigarettes again (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of slim cigarettes that tried to quit in the 26+ age group (N=512)  
Question: Q.2.3. Why did you start to use slim cigarettes again? Please select up to 2 options.  
Note: Each bar represents the proportion of respondents that selected the option within the age group. 
The percentages do not add up to 100% because of the fact that respondents could select more than one 
term – therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

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3.2.3 Parallel use with other tobacco and related products 

The survey found that a large majority of current of slim cigarettes smokers were dual users i.e. using 
another  tobacco  product  in  parallel.  In  the  18-25  age  group,  81%  used  slim  cigarettes  with  other 
tobacco  products,  mainly  conventional  cigarettes  (also  see  Figure  190  in  Annex).  The  focus  group 
participants did not see much difference between these two products with the choice between them a 
matter of personal preference:  

“I  am  speaking  about  the  cigarettes  and  the  slims.  They  are  the  easiest  to  consume 
because you don’t need to roll them, all you need is a lighter and that is all.” (M, 20, FR) 

“These are in small quantities, because it’s true that when we take the normal cigarette, 
we may not smoke it until the end because we get sick of it after a while. Whereas with 
these slim ones, it’s just what you need.” (F, 49, FR) 

“I smoke slims when I want a lighter cigarette.” (M, 24, BG) 

Table 27 and Table 28 chart the career flows of current slim cigarette users. In the 18-25 age group 
14% of current users had transitioned from other products, mainly conventional cigarettes to consume 
slim  cigarettes  exclusively:  5%  were  ‘only  ever’  slim  cigarette  smokers  and  89%  of  current  slim 
cigarette  smokers  were  dual  users  with  85%  reporting  the  smoking  of  conventional  cigarettes.  A 
similar pattern is evidenced for the 26+ age group: 17% transitioned from other tobacco products, 
5% were only ever  slim cigarette smokers and 78% reported dual use with 95% of them  smoking 
conventional cigarettes in parallel. 

Table 27. Career flows of slim cigarette use for current users (18-25 age group) 

Percentage and number of current users in the 18-25 age group  

Never users of other products 
Exclusive current user of slim cigarettes & past user of other product(s) 

Out of them, switching from (one or more products) * 

Total 

Number  % 
100 
5 
14 

656 
34 
89 

Cigarettes 

Waterpipe tobacco 

Electronic cigarettes 

HTPs 

Small cigarillos 

(n=76) 

(n=21) 

(n=14) 

(n=14) 

(n=6) 

85% * 

24% * 

16% * 

16% * 

7% * 

Current user of slim cigarettes & both current and past user of other product(s) 

533 

81 

Other products consumed in parallel now * 

Cigarettes 

E-cigarettes 

HTPs 

(n=452) 

85% * 

(n=274) 

51% * 

(n=228) 

43% * 

Waterpipe tobacco 

(n=226) 

42% * 

Small cigarillos 

(n=216) 

41% * 

Base: current users of slim cigarettes in the 18-25 age group (N=656) 
Question: Q.1.1. Have you ever used slim cigarettes? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of current users. 
A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last row only 
provides the breakdown of current dual use as this is the variable of interest; it does not include a breakdown 
that takes account past consumption of products to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 28. Career flows of current slim cigarette users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Never users of other products 
Exclusive current user of slim cigarettes & past user of other product(s) 

Out of them, switching from (one or more products) * 

Total 

Number  % 
100 
5 
17 

725 
34 
124 

Cigarettes 

(n=113) 

91% * 

Electronic cigarettes 

Small cigarillos 

HTPs 

Waterpipe tobacco 

(n=19) 

(n=18) 

(n=18) 

(n=9) 

15% * 

14% * 

14% * 

7% * 

Current user of slim cigarettes & both current and past user of other product(s) 

567 

78 

Other products consumed in parallel now * 

Cigarettes 

E-cigarettes 

HTPs 

(n=503) 

95% * 

(n=284) 

50% * 

(n=251) 

44% * 

Small cigarillos 

(n=237) 

42% * 

Waterpipe tobacco 

(n=173) 

31% * 

Base: current users of slim cigarettes in the 26+ age group (N=725) 
Question: Q.1.1. Have you ever used slim cigarettes? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of current users. 
A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last row only 
provides the breakdown of current dual use as this is the variable of interest; it does not include a breakdown 
that takes account past consumption of products to avoid confusion (from too many permutations).  
 (*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

Table 29 and Table 30 depict the career flows for past slim cigarette smokers. In the 18-25 age group, 
of all past users of slim cigarette, 14% had been used the product exclusively in the past and had now 
switched  to  another  product,  mainly  traditional  cigarettes.  Furthermore,  29%  had  been  dual  users 
and had now quit all tobacco products and 53% were former slim cigarettes smokers who were now 
using other tobacco and related products, mainly conventional cigarettes.  

In the 26+ age group, 42% of past slim cigarette smokers now used other tobacco products. 39% of 
dual users had quit all tobacco products and 42% were past and  current dual users  of whom 68% 
reported smoking traditional cigarettes.  

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Table 29 Career flow of past slim cigarette users (18-25 age group) 

Percentage and number of past users in the 18-25 age group 

Never user of other products  

Dual past user & not using any products now 

Total 

Exclusive past user of slim cigarettes & current user of other products (but not slim 
cigarettes) 

Out of them, switching to (one or more products) * 

Number 

 % 

802 

100 

31 

236 

112 

4 

29 

14 

Cigarettes 

Electronic cigarettes 

HTPs 

Waterpipe tobacco 

Small cigarillos 

(n=98) 

(n=22) 

(n=22) 

(n=21) 

(n=11) 

87% * 

20% * 

20% * 

19% * 

19% * 

Dual past user & current user of other products (but not slim cigarettes)  

423 

53 

Other products currently consumed in parallel (one or more products) * 

Cigarettes 

E-cigarettes 

HTPs 

Waterpipe tobacco 

Small cigarillos 

(n=251) 

59% * 

(n=152) 

36% * 

(n=122) 

29% * 

(n=94) 

(n=50) 

22% * 

12% * 

Base: past users of slim cigarettes in the 18-25 age group (N=802) 
Question: Q.1.1. Have you ever used slim cigarettes? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 30 Career flows of past slim cigarette users (26+ age group) 

Percentage and number of past users in the 26+ age group 

Never users of other products 

Dual past user & not using any products now 

Total 

Exclusive past user of slim cigarettes & current user of other products (but not 
slim cigarettes) 

Out of them, switching to (one or more products) * 

Number 

 % 

864 

24 

335 

141 

100 

3 

39 

16 

Cigarettes 

(n=191) 

96% * 

Electronic cigarettes 

HTPs 

Small cigarillos 

(n=40) 

(n=38) 

(n=15) 

20% * 

19% * 

10% * 

Waterpipe tobacco 

(n=11) 

6% *  

Dual past user & current user of other products (but not slim cigarettes) 

364 

42 

Other products currently consumed (one or more products) * 

Cigarettes 

E-cigarettes 

HTPs 

Waterpipe tobacco 

Small cigarillos 

(n=248) 

68% * 

(n=174) 

48% * 

(n=114) 

31% * 

(n=59) 

(n=44) 

16% * 

12% * 

Base: past users of slim cigarettes in the 26+ age group (N=864) 
Question: Q.1.1. Have you ever used slim cigarettes? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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3.3  Consumer perception 

While the literature pointed to the promotion of slim cigarettes as elegant, high status and appealing 
to women, the survey data showed an almost even prevalence of slim cigarette smoker in women and 
men. However, the focus group participants repeatedly mentioned femininity in association with slim 
cigarettes:  

“I would say they are feminine.” (M, 34, ES)  

“I would rather say those long cigarettes, the cigarettes are for ladies.” (F, 27, DE) 
referring to slim cigarettes 

“Back in the 20's it was acceptable to smoke them. They had sticks to make them 
longer as they were wearing white gloves, to prevent them from turning yellow. So, 
they had something to help them hold it.” (M, 49, DE)  

“Right, feminine. I couldn't imagine a man smoking these.” (M, 30, DE)  

“To me it's a fad, I've never smoked them.” (F, 54, DE) 

Another  association  for  the  participants  reflected  wealth  and  status.  Participants  considered  that 
tobacco  products  were  costly,  especially  in  terms  of  taxes,  but  this  was  not  considered  a  major 
drawback for a status symbol. 

“They have a higher economic status.” (M, 34, ES)  

“I started with conventional cigarettes and when I started earning more money, I 
started using the slims.” (M, 20, ES) 

“Slim cigarettes are expensive.” (F, 41, EL)  

In the survey economic resources were an important factor in the decision to consume slim cigarettes 
or not. The second most cited reason for attempting to quit smoking slim cigarettes was for economic 
reasons, after personal health reasons (see Figure 50). The focus group participants suggested that 
slim cigarettes were no longer considered a trend, but rather a timeless fashion. They were associated 
with professional and business-oriented environments and were known to be particularly popular in 
Russia. The product evoked a universe of exclusivity, of higher status, and modernity. Accordingly, it 
was considered an expensive product that conveyed an image of sophistication, luxury and frivolity. 
The thinner packaging was also perceived as more elegant and handier.  

“It (slim cigarette) is more elegant.” (F, 43, EL); when asked why she chose slim 
cigarettes over conventional ones 

“Yes, we like it when it’s ergonomic, compact and small. Something that will not be 
cumbersome.” (M, 20, FR)  

“More elegant and sophisticated.” (M, 32, ES)  

“The attribute fancy-schmancy.” (F, 63, DE)  

Slim cigarettes were also associated with hedonism, bon-vivant and a pleasure-oriented atmosphere, 
imagery most likely based on the portrayal of the higher classes of the 1920s with their long cigarette 
holders, the Charleston and not “real” smokers.  

The  online  survey  showed  current  usage  of  slim  cigarettes  at  11%  for  the  18-25  age group  (see 
Figure 35) and 12% for the 26+ age group (see Figure 36). Bulgaria and Poland had high prevalence 
of  slim  cigarette  users  in  both  age  groups.  In  the  18-25  age  group,  23%  of  respondents  reported 
current  use  of  slim  cigarettes  in  Bulgaria,  with  only  35%  of  never  users.  By  contrast,  75%  of 
respondents  in  Germany  had  never  tried  the  product  (i.e.  never  users).  In  the  26+  age  group,  a 

87 

 
 
Consumer preference and perception of specific categories of tobacco and related products 

majority  had  never  tried  slim  cigarettes,  but  this  varied  significantly  across  the  countries  studied, 
ranging from the 35% to 75% of never users.  

Slim cigarettes were also perceived as more “discreet” and “lighter”, with apparently less smell than 
conventional cigarettes. However, the act of smoking slim cigarettes was also sometimes experienced 
as too short or fast and that it might lead consumers to smoke a greater quantity of slim cigarettes 
to feel as satiated as compared to a traditional cigarette.  

“We get the impression that it’s milder and so less harmless but it’s just as harmful.” 
(M, 28, FR) 

“(…) I need three of them to get the effect of one cigarette, I'm not sure why. It's 
weird.” (M, 22, DE)  

“You might think they are light, but you end up smoking a lot more of them. It's 
pseudo healthy.” (M, 49, DE) 

Due to this characteristic, it was sometimes falsely assumed that the slim cigarettes were less harmful 
than  conventional  cigarettes  because  they  contained  less  tobacco  and  had  a  “lighter”  taste.  The 
opinion  was  particularly  shared  in  Greece,  where  slim  cigarettes  were  associated  with  brands  that 
produced low tar and low nicotine cigarettes. The misconception of reduced harmfulness meant that 
participants sometimes assumed the product could be used as a transitional product to quit smoking 
and were more likely to infer that the product was more acceptable within society.  

“I started smoking this because, even though it is slightly longer than a cigarette, 
less tobacco is smoked.” (F, 54, ES) 

“I don’t like to bother, also it is lighter, I smoke slim occasionally, when I want to 
relax.” (F, 41, EL)  

“It is thinner and, in theory, it has less quantity of tobacco.” (M, 20, ES)  

“We can say that they are for people that wish to quit cigarettes.” (M, 28, FR) 

Figure  54  and  Figure  55  show  the  results  of  the  ‘swing  method’  to  assess  risk  perceptions  of  slim 
cigarettes  and  the  other  tobacco  and  related  products  included  in  this  study  plus  conventional 
cigarettes. The swing method is explained in section 1.3.3. In brief, the respondent is asked which of 
the six products they think is most damaging to a user’s health. This product is given 100 points on a 
scale from 100 (most harmful) to 0 (not harmful). Then using this scale, the respondent is asked to 
rate each of the other five products on its harmfulness to health of users.  

In the 18-25 age group (see Figure 54), conventional cigarettes at a score of 82 are seen as the 
most  harmful  to  health  of  the  six  products.  Slim  cigarettes  ranked  third  highest  in  terms  of 
harmfulness  to  the  users’  health  about  the  same  as  small  cigarillos).  Current  users  perceived  slim 
cigarettes as less harmful than ‘past’ ‘once or twice’ and ‘never’ users. Current users gave a score of 
57 out of 100 (where 100 represents the most damage to the users’ health) to e-cigarettes, in contrast 
to 68 for ‘never’ users. 

The findings on perceived harmfulness in the 26+ age group (see Figure 55) are broadly similar to 
those of the 18-25 age group (see Figure 166 in the Annex for further details). Conventional cigarettes 
at 82 were seen as most harmful. Slim cigarettes at 60 are seen as equally harmful as small cigarillos. 
Current e-cigarette users of gave a score of 55 compared to 59 for never users. 

In the focus groups participants commented on current trends towards healthier lifestyles, notably for 
the younger generations. That the 26+ age group were more aware of the harmful effects associated 
with slim cigarettes than the 18-25 age group confirms that view.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 54. Perceived harmfulness of slim cigarettes to users (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.1.a.52 & Q.3.1.b. You have chosen (e.g. cigarettes, except slims53) as likely to be the most 
damaging to the health of users. We will give (e.g. cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g. cigarettes,  except slims),  you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
small  cigarillos  user  profiles,  and  therefore  differs  from  the  other  chapter.  The  products  are  sorted  in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

52 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
53 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

89 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 55. Perceived harmfulness of slim cigarettes to users (26+ age group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910)  
Question: Q.3.1.a.54 & Q.3.1.b. You have chosen (e.g. cigarettes, except slims55) as likely to be the most 
damaging to the health of users. We will give (e.g. cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g. cigarettes,  except slims),  you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
slim  cigarette  user  profiles,  and  therefore  differs  from  the  other  chapter.  The  products  are  sorted  in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

Slim cigarettes were considered as a harmful product that closely resembled conventional cigarettes 
because it had the same paper, filters and tobacco – which provides a potential explanation for why 
current  users  in  the  18-25  age  group  ranked  slim  cigarettes  as  slightly  more  harmful  than  small 
cigarillos.  

“Well yes, it’s the slim. It has all the chemicals.” (F, 48, FR); in response to which 
was the most harmful product under the scope 

“It tries to look different from normal tobacco and, in the end, you are smoking the 
same thing.” (M, 31, ES)  

“That tobacco is rolled in paper which has several things we don't know.” (F, 54, 
ES) 

54 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
55 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

90 

 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 56 and Figure 57 focus on the passive smoking health risk of slim cigarettes. The 18-25 age 
group  (see  Figure  56)  assessed  slim  cigarettes  as  the  most  harmful  product  to  bystanders  after 
traditional cigarettes and just as harmful to bystanders as to smokers. While harm the risk to others 
was widely acknowledged, it was not cited as a common reason for quitting the use  of this product 
(see Figure 50). The 26+ age group (see Figure 57) assessed the passive smoking risk as the same 
as small cigarillos. As with the younger age group, the risk of harm to bystanders was seen as about 
the same as the risk to users. 

Figure 56. Perceived harmfulness of slim cigarettes to bystanders (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.2.a.56 & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 57) as likely to be 
the most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims ) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims ), you would give it 100 points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for small cigarillo user profiles, and therefore differs from the other chapter. The products are 
sorted in descending order of the average score provided by the “group total,” i.e. amongst all respondents 
of that age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

56 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
57 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

91 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 57. Perceived harmfulness of slim cigarettes to bystanders (26+ group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.3.2.a.58 & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 59) as likely to be 
the most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims ) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims ), you would give it 100 points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for slim cigarette  user profiles,  and therefore differs from the other chapter. The products are 
sorted in descending order of the average score provided by the “group total,” i.e. amongst all respondents 
of that age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

58 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
59 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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3.4  Health, social and economic impacts 

The impacts of conventional tobacco smoking, including slim cigarettes, have been studied in greater 
depth than the other products featured in this study. Most research includes slim cigarettes with other 
types of cigarette-like products; therefore, the present section relies in part on findings that are not 
exclusive to slim cigarettes. The economic costs of tobacco use are substantial and include significant 
healthcare  costs  for  treating  tobacco-related  diseases  as  well  as  the  loss  of  human  capital  due  to 
tobacco-attributable morbidity and mortality. It has been suggested that about 15% of the aggregate 
health care expenditure in high-income countries can be attributed to smoking (Epku & Brown, 2015). 
Smoking also poses considerable indirect costs to society as it may affect second-hand smokers, it 
can cost employers in the form of loss of productivity and absenteeism of smokers due to illnesses, 
and it pollutes the environment (Epku & Brown, 2015).  

Cigarette-like products are known to be highly toxic and can exert multiple effects on the pulmonary 
system, such as inflammation, DNA breaks as well as deranging the mucus clearance system (Ghosh 
et al., 2017). Some super-slim brands have been found to contain more dangerous tobacco chemicals 
than  their  larger  counterparts  (Ford  et  al.,  2013).  However,  other  studies  have  noted  that  slim 
cigarettes may reduce exposure to tar and other chemical substances found in cigarettes due to the 
reduced amount of tobacco within the cigarette stick. For instance, a study by Talhout et al. (2018) 
found reduced emissions of some but not all smoke components. The level of intoxication is not only 
dependent on the format, but also on the way in which the product is inhaled and the type of tobacco 
smoked. Reducing the circumference of the rod also reduces the “smoke velocities”, i.e. the time for 
the smoke to pass from the coal to the mouth end of the cigarette, which in turn decreases filtration 
and retention of harmful chemicals in the filter (Talhout et al., 2018). Furthermore, the study found 
that  there  may  be  evidence  for  compensatory  behaviour  linked  to  the  design  of  slim  cigarettes.  It 
should be noted that the study was based on smoke emissions measured from a machine, which do 
not translate directly to actual human exposure.60  In terms  of harm to  passive users, second-hand 
smoke has been found to cause serious cardiovascular and respiratory diseases, including coronary 
heart disease and lung cancer. In pregnant women, it causes pregnancy complications and low birth 
weight, while it also raises the risk of sudden infant death syndrome for young children.61 

While the harmfulness of tobacco is widely known, many studies have demonstrated that slim cigarette 
users misinterpret the small circumference of the product for reduced harmfulness and that the design 
increases appeal among vulnerable groups (see section 3.1). In terms of social impact, some studies 
have also shown that there is a high prevalence of smoking among disadvantaged population groups 
(Milcarz et al., 2017, Poland, N=1,817), who may not have the resources to sustain such a habit but 
have developed an addiction for it.62 In fact, tobacco use has been said to contribute to poverty by 
diverting  economic  resources  from  basic  needs  (e.g.  food  and  shelter)  to  tobacco.  This  spending 
behaviour is difficult to curb because tobacco is so addictive. 

In  terms  of  excise  duty  applied  to  manufactured  tobacco,  the  Council  adopted  the  Tobacco  Excise 
Directive (2011/64/EU), which updated the common fiscal legislation on tobacco products in the EU. 
Following the directive, slim cigarettes are taxed as cigarettes. 

60 In other words, they do not account for individual use behaviours.  
61 https://www.who.int/news-room/fact-sheets/detail/tobacco 
62 Most of the respondents in the study showed willingness to quit.  

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Table 31. Tax provisions applicable to manufactured tobacco 

Product 

Tax structure 

Slim cigarettes 
(same as 
normal 
cigarettes) 

  Mandatory mixed structure including both an ad valorem excise duty and a specific 
excise duty, which must be between 7.5% and 76.5% of total tax burden (since 
Jan. 2014). 

  At least 60% of weighted average price (WAP) and no less than EUR 90 per 1,000 

cigarettes; or EUR 115 per 1,000 cigarettes. 

  A  minimum  excise  duty  (MED)  may  apply  (i.e.  a  fixed  monetary  amount  per 
quantity applicable if the amount of the excise duty falls below a minimum floor). 

Source: Own elaboration 

The regulation and tax measures were aligned with those of conventional cigarettes. Passport data 
showed  that  the  highest  specific  tax  on  slim  cigarettes  was  applied  in  Ireland,  the  UK  and  the 
Netherlands  as  of  2017  (see  Figure  175).  Increasing  prices  of  tobacco  products  through  taxes  has 
been shown to decrease smoking prevalence as well as the quantity of cigarette sticks smoked per 
day  (Ekpu  &  Brown,  2015;  Ranabhat  et  al.,  2019).  Talhout  et  al.  (2019)  examined  the  physical 
cigarette  design  features  and  how  they  affected  smoke  emissions,  product  appeal  and  smoking 
behaviours. The study found that slim cigarettes were usually perceived as relatively safe and  high-
quality  products,  which  translated  into  a  stronger  appeal,  particularly  for  women.  One  study  also 
showed that smokers often perceived longer cigarettes to be attractive and of high quality (Borland & 
Savvas, 2013), while another (although based in Australia) suggested that standard cigarette sticks 
were perceived as the highest quality and the most attractive product in terms of length/diameter for 
men, and that they were more inclined to rate a slim stick as less attractive (Borland, 2012, N=160). 
In addition, Ford et al. (2013, UK) showed that that slim and super-slim cigarettes with white filters 
and decorative features were viewed most favourably across gender and socio-economic groups. The 
smaller diameter motivated a perception of lower harm among (mostly) non-smoking adolescents. In 
general, the view was that because they contain less tobacco, they must, therefore, be less harmful. 
To reduce the possibility of cigarette appearance misleading consumers, the European Commission’s 
draft  Tobacco Products  Directive proposed banning cigarettes <7.5 mm in diameter.  However, this 
ban has not been included in the final Tobacco Products Directive,63 but should be closely monitored 
in the future.  

63  European  Parliament.  European  Tobacco  Products  Directive  2014/40/EU.  [Accessed  August  25,  2017];  Available  at: 
http://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdf 

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3.5  Concluding remarks on slim cigarettes 

This  section  summarises  the  main  findings  that  emerged  from  the  research  conducted  on  slim 
cigarettes. The systematic review of secondary sources revealed: 

  Slim cigarettes are tobacco products in which their length and circumference, is modified to 
increase their appeal. However, slim cigarettes have the equal or very similar harm potentials 
as other cigarettes. 

  The  tobacco  industry  made  slim  cigarettes  a  symbol  of  gender  equality,  sophistication  and 
upward  mobility.  Smoking  was  made  to  look  fun,  glamorous,  healthy,  liberating,  relaxing, 
sexually attractive, slimming and sophisticated. Coloured packs were also developed to attract 
children. 

  The slim cigarettes’ market development varies greatly across the EU in absolute terms. Some 
have  grown  substantially  while  others  have  seen  a  decrease.  However,  the  share  of  slim 
cigarettes  in  the  cigarette  market  has  grown  over  the  past  years  in  most  countries  and 
particularly in Eastern Europe (Passport, 2017). 

  The regulation and tax measures for slim cigarettes were aligned with those on conventional 

cigarettes in the EU. 

  Eurobarometer 458 found that the prevalence of slim cigarette use was 10% among females 
and 2% among males in 2017. Almost 1 in 5 respondents of the Eurobarometer believed that 
slim cigarettes were attractive. 

The empirical work (focus groups and online survey) revealed the following user profile: 

  The online survey found high consumption of slim cigarettes in Bulgaria and Poland.  

  While more women than men were users of slim cigarettes the difference at 2% was relatively 

small for the 18-25 age group it rose to 5% for the 26+ age group.  

  A typical current user consumes slim cigarettes daily and between 1 and 10 sticks every day 
of use. The majority started smoking slim cigarettes for enjoyment or to socialise. The younger 
respondents were more likely to have started as minors. A large majority of current users of 
slim cigarettes were also using other tobacco and related products. 

  About 7 in 10 current users had tried to quit for personal health reasons or economic reasons. 
However,  they  failed  to  do  so  because  of  stress,  they  had  used  them  on  one  occasion  and 
ended up starting again, or it was too difficult to stop. 

  A typical past user smoked at least once a week and between 1 and 10 sticks every day that 
he or she smoked. About 80% of former slim smokers were dual users. In the 18-25 age group, 
37% have quit using all tobacco and related products under study, while 63% continued using 
them. These figures were 45% and 55%, respectively, in the 26 group. 

Lastly, the following paragraphs highlight the Product and Regulatory perceptions remarks 

  General perception, including price. Slim cigarettes have a connotation of femininity; however, 
this perception is less strongly rooted than it has been in the past. Slim cigarettes and their 
thinner packaging are also perceived as a product related to higher economic status, elegance, 
exclusivity and modernity. Accordingly, it was considered an expensive product. On the other 
hand,  it  was  also  sometimes  conveyed  a  hedonistic,  bon-vivant  and  pleasure-oriented 
atmosphere.  This  could  also  be  associated  with  status-seekers  who  are  rather  frivolous  and 
not “real” smokers.  

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Consumer preference and perception of specific categories of tobacco and related products 

  Perception  of  harmfulness.  Slim  cigarettes  were  perceived  as  “lighter”,  with  less  smell  than 
conventional cigarettes.  It was also considered not as  rewarding  as conventional cigarettes. 
Users  judged  them  to  be  less  harmful  to  their  health  and  to  bystanders  than  conventional 
cigarettes. However, they were considered one of the most harmful products, along with small 
cigarillos. Never-users, compared to current users, perceived slims as more dangerous.  

  Perception of marketing practices. The design of the product and its packaging have been found 
to impact the perception of the product. The product was historically marketed to target young 
women.  Marketing  practices  on  this  type  of  product  have  been  heavily  regulated  at  the  EU 
level. Accordingly, not many mentions were made to advertisements in the online survey nor 
in focus group discussions.  

  Regulatory support. Slims are recognised as conventional tobacco products from the regulatory 

point of view.  

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Consumer preference and perception of specific categories of tobacco and related products 

4  Small cigarillos 

4.1  Background 

The systematic literature review found very few articles on the perception and consumption of small 
cigarillos  in  the  EU.  However,  information  from  the  USA  was  widely  available,  in  part  due  to  the 
growing popularity of the product among specific population subgroups. A study by RAMBOLL (2014) 
found that the consumption of small cigarillos had increased in most EU Member States in the early 
2010s.  For  instance,  Latvia  reported  a  very  substantial  increase  in  the  consumption  of  cigars  and 
cigarillos between 2009 and 2010, while cigarette consumption decreased by 23%. The increase in 
consumption in Latvia was almost entirely attributed to the release of cigarillos by the brand, Partner. 
According to the Eurobarometer 458, the prevalence of regular and former users of cigarillos remained 
relatively stable between 2014 and 2017 in the EU – with only 3% of respondents reporting regular 
current use in 2017. The Eurobarometer 458 also noted a slight decrease in the number of respondents 
that  had  tried  cigarillos  and/or  cigars.  12%  of  respondents  reporting  consuming  the  product  in 
December 2014 compared to 8% in March 2017.64  

Market developments. The figure below presents the structure of the EU market of small cigarillos 
in absolute values (million euros) by country. Germany (659 m EUR) and France (483 m EUR) had 
the largest market for small cigarillos in the EU in 2017, accounting for almost half of the entire EU 
small cigarillos market. They were  followed by Spain (256 m EUR), the UK (153 m  EUR) and  Italy 
(120 m EUR).  

Figure 58. Market size of small cigarillos in million euro in 2017 

Note: The market size is estimated total sales in million euros for 2017, without population 
adjustments. It is displayed as a tree map graph that consists of series of nested rectangles of 
sizes proportional to the corresponding data value. 

Source: OE elaboration of Passport, 2017 

64  There  was  a  slight  modification  in  the  Eurobarometer  458  which  clarified  the  definition  of  the  two  items  (i.e.  clearly 
distinguished the two products).  

97 

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Consumer preference and perception of specific categories of tobacco and related products 

The  map  below  presents  the  share  of  small  cigarillos  in  the  national  tobacco  markets  across  EU 
countries.  The  share  of  small  cigarillos  in  the  Finnish  tobacco  market  was  particularly  high  in 
comparison to other Member States, reaching over 5%. France, Germany, Lithuania and Latvia also 
appeared  to  be  significant  markets  –  all  reaching  a  share  of  at  least  2.5%  in  the  national  tobacco 
market.  

Figure 59. Share of small cigarillos within the national total tobacco market, per country (2017) 

Note: Percentage share of small cigarillos were estimated with respect to the whole tobacco market in the 
country in million euros. 
Source: OE elaboration of Passport, 2017 

The distribution of the prices on small cigarillos in 2017 showed significant variation across Member 
States (see Figure 60). The prices were highest in Romania and Croatia. Based on the available data, 
the lowest prices were found in Hungary and Spain.  

Figure 60. Price of small cigarillos in 2017, euros per unit (stick) 

Note: EU average is calculated for 25 EU MS (excluding Cyprus, Luxembourg & Malta) 
Source: Passport, 2017 

98 

0,00,10,20,30,40,50,60,70,8HUESLVLTDENLPTBEDKPLITELSKFRATEUCZFIUKSEBGEESIIEHRRO 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

From  2012  to  2017  the  small  cigarillo  market  followed  an  upward  trend  in  terms  of  current  retail 
selling price (RSP) across a majority of EU countries (see Figure 61). The most significant growth in 
terms of retail selling price occurred in Hungary with a four-fold increase in retail sales price between 
2012 and 2017. The Czech Republic saw a four-fold increase in real volume while Denmark saw the 
largest decrease. It is also important to note that there has been a decline in the growth in volume of 
small cigarillos in Europe overall.  

Figure 61. Market size trends of small cigarillos over 2012-2017  

Note: EU average is calculated for 25 EU MS (excluding Cyprus, Luxembourg & Malta) 
Source: Passport, 2017 

In  the  USA,  Regan  (2012,  USA,  N=1,556)  reported  that  the  marketing  strategies  of  the  industry 
targeted  young  adults,  that  use  of  flavoured  small  cigarillos  was  much  more  common  among  the 
youth, and that certain demographic groups were more likely to be influenced by tobacco marketing, 
including males, young adults, and people with low income or education. A study conducted by Harrell 
(2017, USA, N=TATAMS (2483); M-PACT (4326)) also found evidence that flavoured tobacco products 
had a high appeal among young people (aged 12-17) and young adults (aged 18-29). While these 
studies are specific to the USA, the marketing strategies have been used online, to which European 
citizens may be exposed. 

Consumer perception. Kostygina et al. (2016, USA) argued that tobacco companies had engaged 
in efforts to blur the line between little cigars and cigarettes to increase appeal, and that the use of 
flavours had facilitated these efforts. They found that the addition of flavours masked the harshness 
of tobacco products and made it easier for users to inhale the smoke, which in turn made the product 
appear less harmful and more palatable to younger users. Cornacchione et al. (2016, USA) also found 
that participants generally had positive associations with little cigars and cigarillos (LLCs). They could 
be used in social gatherings, they came in various flavours, and they could be used to perform smoke 
tricks. 

Sterling et al. (2015, USA, N=90) conducted focus group interviews to gain a better understanding of 
the perceptions and behaviours of young adult smokers aged 18-34 years old with respect to flavoured 

99 

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Consumer preference and perception of specific categories of tobacco and related products 

LCC products. The participants were excited and fascinated by them and agreed that flavoured tobacco 
made smoking LCCs more palatable. The design of the packaging also influenced the young adults’ 
liking and the consumption patterns, stimulating the switch from cigarettes to flavoured LCCs.  

In  a  US  survey  few  adults  were  found  to  believe  that  LLCs  were  less  harmful  to  their  health  than 
cigarettes (Regan, 2012). In Europe, LLCs were marketed as cigars, i.e. with a lower excise duty, in 
some markets including Spain, Portugal, Latvia and Lithuania (RAMBOLL, 2014). Nevertheless, they 
were perceived as a substitute for cigarettes.  

Impacts.  Research  on  small  cigarillos  typically  has  not  distinguished  the  product  from  cigars  and 
other  cigar-like  products.  However,  small  cigarillos  have  been  assumed  to  lead  to  similar  health 
problems  to  conventional  cigarettes.  The  industry  has  increasingly  developed  small  cigarillos  as  a 
cigarette substitute, as the product attracted lower taxation than traditional tobacco products and was 
exempt from bans on flavourings. The increasing global reach of social media and its role in indirect 
product promotion has been noted in the USA (see section 4.4 for more information on the health, 
social and economic impacts of small cigarillos).  

4.2  Market developments  

4.2.1 Socio-demographic characteristics  

Across the countries surveyed in the 18-25 age group 6% were current users of small cigarillos, 9% 
past users and 65% never users (see Figure 62). The highest percentage of current users was found 
in the United Kingdom (11%), followed by Spain (7%) and France (7%). Across all surveyed countries, 
the share of former users was higher than current users for this age group.  

Figure 62. Use of small cigarillos: country breakdown (18-25 age group)  

Percentage of all respondents in the 18-25 age group 

Base: all respondents in the 18-25 age group (N=6,090) 
Question: Q.1.1. Have you ever used small cigarillos? 
Note: The group total category refers to all respondents within the age group. 
Source: OE elaboration from online survey data 

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Figure 63. charts the pattern of use for small cigarillos in the  26+ age group. Of the total sample 
58% reporting never use of small cigarillos, 23% had tried the product once or twice and 7% were 
current users. Similar to the 18-25 age group, the percentage of past users was consistently higher 
than the current users. Of note is that the UK had the highest percentage of current users never users 
in the 18-25 age groups and the highest percentage of never users in the 26+ age group.  

Figure 63. Use of small cigarillos: country breakdown (26+ age group) 

Percentage of all respondents in the 26+ age group 

Base: all respondents in the 26+ age group (N=5,910) 
Question: Q.1.1. Have you ever used small cigarillos? 
Note: The group total category refers to all respondents within the age group.  
Source: OE elaboration from online survey data 

Table 32 and Table 33 report the socio-demographic breakdown in relation to small cigarillos. In both 
age groups there was a substantially high percentage of male over female current smokers of small 
cigarillos, with a larger gender gap in the 18-25 age group. In the 26+ age group, 68% of females 
were never users as compared against 48% of males. Another similarity across the two age groups 
was that more current users reported high socio-economic status and fewer never users.  

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Table 32. Small cigarillo use socio-demographic breakdown (18-25 age group) 

Percentage and number of all respondents in the 18-25 age group 

Group total  
% (n) 

Current users  
% 

Past users 
% 

Used once or twice  
% 

Never users  
% 

Use of product 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 
(6090) 

47 
(2869) 

53 
(3221) 

5 
(335) 

63 
(3829) 

32 
(1926) 

65 
(3949) 

19 
(1173) 

16 
(968) 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

18 
(1126) 

65 
(3954) 

17 
(1010) 

5 

5 

12 

6 

9 

3 

9 

12 

6 

11 

13 

5 

7 

6 

6 

4 

8 

9 

9 

11 

6 

8 

8 

13 

21 

65 

22 

20 

19 

21 

21 

23 

18 

16 

19 

22 

19 

58 

70 

58 

66 

63 

62 

65 

74 

69 

66 

57 

Base: all respondents in the 18-25 age group (N=6,090) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

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Table 33. Small cigarillo use socio-demographic breakdown (26+ age group) 

Percentage and number of all respondents in the 26+ age group 

Group total 
% (n) 

Current users  
% 

Past users  
% 

Used once or twice  
% 

Never users  
% 

7 

12 

23 

58 

Use of product 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 

(5910) 

52 

(3074) 

48 

(2836) 

5 

(308) 

46 

(2704) 

49 

(2898) 

66 

(3879) 

17 

(1010) 

17 

(1021) 

10 

5 

9 

7 

7 

8 

8 

4 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

23 

(1374) 

64 

(3769) 

13 

(767) 

4 

7 

16 

15 

9 

12 

10 

14 

13 

11 

9 

9 

12 

17 

27 

19 

19 

22 

24 

25 

18 

19 

23 

23 

22 

48 

68 

59 

61 

55 

53 

63 

69 

64 

58 

46 

Base: all respondents in the 26+ age group (N=5,910) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

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4.2.2 Pattern of use  

Figure 64. and Figure 65. report the frequency of smoking small cigarillos. In the 18-25 age group 
39% were smoking daily and 33% once a week. These figures translate to approximately 2% of the 
overall sample of 6,090 (see Figure 64). A similar pattern was observed in the 26+ age group with 
33% smoking daily and 40% weekly, translating to approximately 3% of the overall sample of 5,910 
(see Figure 65). 

Figure 64. Frequency of use of current small cigarillo users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of small cigarillo in the 18-25 age group (N=355) 
Question: Q.1.3. How often do you use small cigarillos? 
Source: OE elaboration from online survey data 

Figure 65. Frequency of use of current small cigarillo users ( 26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of small cigarillo in the 26+ age group (N=429) 
Question: Q.1.3. How often do you use small cigarillos? 
Source: OE elaboration from online survey data 

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Figure 66 and Figure 67 report the frequency of use among past small cigarillo users. In the 18-25 
age group 20% were smoking daily and 42% weekly. Similar percentages were found in the 26+ age 
group, 21% daily and 39% weekly. Past users of small cigarillos appeared to be less frequent users 
than current user peers for both age groups respectively.  

Figure 66. Frequency of use of past small cigarillo users (18-25 age group) 

Percentage and number of past users in the 18-25 age group 

Base: past users of small cigarillos in the 18-25 age group (N=536) 
Question: Q.1.6. How often did you use small cigarillos? 
Source: OE elaboration from online survey data 

Figure 67 Frequency of use of past small cigarillo users (26+ age group) 

Percentage and number of past users in the 26+ age group 

Base: past users of small cigarillos in the 26+ age group (N=713) 
Question: Q.1.6. How often did you use small cigarillos? 
Source: OE elaboration from online survey data 

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Figure 68 and  

Figure 69 chart the average number of small cigarillos (sticks) smoked by current users on days when 
they smoke. In the 18-25 age group, 69% of current users reported 1-5 sticks a day, 16% 6-10 
sticks and 15% more than 11 (see Figure 68). In the 26+ age group, 75 reported 1-5 sticks a day, 
17% 6-10 and 8% more than 11 (see  

Figure 69). 

Figure 68. Average number of small cigarillo sticks per day of use (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of small cigarillos in the 18-25 age group (N=355) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

Figure 69. Average number of small cigarillo sticks per day of use (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of small cigarillos in the 26+ age group (N=429) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

The  focus  group  participants  thought  that  small  cigarillos  were  consumed  less  frequently  than 
conventional  cigarettes.  Many  believed  that  the  product  had  a  strong  taste  and  was  a  satiating 
experience  when  compared  to  conventional  cigarettes.  As  such  it  was  not  necessary  to  smoke  as 
many.  

“A  replacement  for  cigarettes  because  they  are  cheaper  and  you  don't  need  as 
many. The taste is more intense.” (M, 49, DE) 

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“It’s occasional as well, we don’t do that every day!” (F, 53, FR) 

“1-2 small cigarillos a day are better than 20 cigarettes.” (M, 38, BG) 

Figure 70 and Figure 71 focus on the number of sticks smoked by daily users of small cigarillos. It is 
worth bearing in mind that the percentage of respondents in this category was relatively small; 2% 
of  the  18-25  age  group  and  3%  of  the  26+  age  group.  In  both  age  groups  one  in  two  daily users 
smoked 1-5 sticks a day. In the 18-25 age group, the share of intensive daily users – defined by 
those that consume more than 10 sticks per day of use – was higher at 22% than in the overall sample 
of current users at 15%. The same pattern was found in the 26+ age group, with 18% of current 
daily users consuming more than 10 sticks per day, as compared to 8% of current users.  

Figure 70. Average number of small cigarillo sticks per day, for daily users (18-25 age group) 

Percentage and number of current daily users in the 18-25 age group

Base: daily current users of small cigarillos in the 18-25 age group (N=138) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

Figure 71. Average number of small cigarillo sticks per day, for daily users (26+ age group) 

Percentage and number of current daily users in the 26+ age group 

Base: daily current users of small cigarillos in the 26+ age group (N=135) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

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On  average,  respondents  that  were  younger  than  23  years  old  in  the  18-25  age  group  were  more 
likely have started smoking small cigarillos under the age of 18 (see Figure 72). Those who were 18 
years of age had been consuming 2 years on average.  

Figure 72. Initiation of use for current and past small cigarillo users (total sample) 

Number of current and past users in the total sample 

Base: current and past users of small cigarillos in the total sample (N=1,91965) 

Question: Q.1.2.a. At about what age did you start using the products below? & Q.5.2. Age 

Note:  The  figure  illustrates  the  approximate  starting  age  of  small  cigarillos  use  among  all  respondents  of  the 
online survey, where the x-axis represents the current age of the respondent (Q.5.2) and the y-axis is the average 
numbers of years of product consumption (calculated by subtracting the current age from the starting age). The 
orange line represents the 45º or 18 y.o. line. Each blue point represents the average starting age for respondents 
of that age; points above the 18 y.o. line reveal those initiating consumption of small cigarillos before the age of 
18, while those below the line reveal age brackets starting consumption after the age of 18 on average. The blue 
lines represent the mean standard deviation, i.e. it does not show the full range of values for each age.   

Source: OE elaboration from online survey data 

The average duration of use for past small cigarillo users in the  18-25 age group was 2 years, as 
displayed in Figure 73. In the 26+ age group, the average duration of use for former users was 10 
years (see Figure 74.). In both groups, the histograms were slightly skewed, suggesting that typically 
people  used  the  product  for  a  shorter  period  of  time.  Participants  in  the  26+  age  group  may  have 
used the product for a longer time due to the addictive nature of the product. They may also have 
had more difficulty quitting.  

65 NA and misreported values are excluded. 

108 

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Figure 73. Duration of use of past small cigarillo users (18-25 age group) 

Number of past users in the 18-25 age group 

Base: past users of small cigarillos in the 18-25 age group (N=47966) 
Question: Q.1.2.a. At about what age did you start using small cigarillos? & Q.1.2.b. At about what age 
did you stop using small cigarillos? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was a past 
user of the product. The mean shows the average duration of use.  
Source: OE elaboration from online survey data 

Figure 74. Duration of use of past small cigarillo users (26+ age group) 

Number of past users in the 26+ age group 

Base: past users of small cigarillos in the 26+ age group (N=66067) 
Question: Q.1.2.a. At about what age did you start using small cigarillos? & Q.1.2.b. At about what age 
did you stop using small cigarillos? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was a past 
user of the product. The mean shows the average duration of use.  
Source: OE elaboration from online survey data 

66 NA and misreported values are excluded. 
67 NA and misreported values are excluded. 

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Figure 75. show the reasons for starting to smoke small cigarillos. The primary reason for taking up 
small cigarillos in the 18-25 age group (see Figure 75.) was ‘for enjoyment’, 4242% reported this 
reason. This was followed by ‘to socialise / it was trendy’ at 22% and ‘everyone else was smoking’ at 
18%. The 26+ age group (see Figure 76.) reported similar reasons; 51% ‘for enjoyment’ and 26% 
‘to socialise / it was trendy’. 

Figure 75. Initiation of small cigarillo use: reasons (18-25 age group) 

Percentage and number of current and past users in the 18-25 age group 

Base: current and past users of small cigarillos in the 18-25 age group (N=891)  
Question: Q.2.1.a. Why did you start using small cigarillos? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages  do  not  add  up  to  100%  because  respondents  could  select  more  than  one  term.  For  the 
response options with “smoking”, the product ‘smoked’ was not specified.  
Source: OE elaboration from online survey data 

Figure 76. Initiation of small cigarillo use: reasons (26+ age group) 

Percentage and number of current & past users in 26+ age group 

Base: current and past users of small cigarillos in the 26+ age group (N=1,142)  
Question: Q.2.1.a. Why did you start using small cigarillos? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages  do  not  add  up  to  100%  because  respondents  could  select  more  than  one  term.  For  the 
response options including “smoking”, the product ‘smoked’ was not specified. 
Source: OE elaboration from online survey data 

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Figure 77 and Figure 78 look at those respondents who had only tried small cigarillos once or twice. 50% 
or the 18-25 age group reported ‘for enjoyment’ and 22% ‘to socialise/it was trendy’. On these two reasons 
the 26+ age group reported higher percentages 54% and 26% respectively. More than one in 10 in both 
age groups cited ‘tobacco advertisements’ which may in part have contributed to the trendy association. 

Figure 77. Initiation of small cigarillo use: reasons for trying small cigarillos (18-25 age group) 

Percentage and number of those who tried once or twice in the 18-25 age group 

Base: those who tried to use small cigarillos in the 18-25 age group (N=1,257)  
Question: Q.2.1.b. Why did you try small cigarillos? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately. For the response options with “smoking”, the type of 
product ‘smoked’ was not specified. 
Source: OE elaboration from study survey data 

Figure 78. Initiation of small cigarillo use: reasons for trying small cigarillos (26+ age group) 

Percentage and number of those who tried once or twice in the 26+ age group 

Base: those who tried to use small cigarillos once or twice in the 26+ age group (N=1,359)  
Question: Q.2.1.b. Why did you try small cigarillos? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately. For the response options with “smoking”, the type of 
product ‘smoked’ was not specified. 
Source: OE elaboration from online survey data 

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Figure  79  and  Figure  80  chart  the  number  of  attempts  by  current  smokers  to  quit  small  cigarillos. 
While the majority of current small cigarillo users reported attempting to quit at least once in both the 
18-25 and the 26+ age groups, 40% in both age groups had never attempted to quit.  

Figure 79. Cessation: attempts to quit small cigarillos (18-25 age group) 

 Percentage and number of current users in the 18-25 age group 

Base: current users of small cigarillos in the 18-25 age group (N=355)  
Question: Q.1.5. Have you ever tried to quit small cigarillos? If yes, how many times? 
Source: OE elaboration from online survey data 

Figure 80. Cessation: attempts to quit small cigarillos (26+ age group) 

 Percentage and number of current users in the 26+ age group 

Base: current users of small cigarillos in the 26+ age group (N=429)  
Question: Q.1.5. Have you ever tried to quit small cigarillos? If yes, how many times? 
Source: OE elaboration from online survey data 

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The reasons for trying to quit smoking small cigarillos are shown in Figure 81 and Figure 82. In both 
age groups reasons around health are the dominant motivation of trying to quit. For the 18-25 age 
groups 22% cited ‘personal health’, 14% ‘health warnings on packages’ and 16% ‘health of people 
around me’. For the 26+ age group the respective percentages on these three health related criteria 
were 25%, 10% and 14%. In aggregate one in two users of small cigarillos are worried about health 
impacts. The charts also show that one in five users tried to quit for economic reasons. 

Figure 81. Cessation: reasons for trying to quit small cigarillos (18-25 age group) 

 Percentage and number of current users in the 18-25 age group who tried to quit 

Base: current users of small cigarillos that tried to quit in the 18-25 age group (N=212)  
Question: Q.2.2. What made you try to quit small cigarillos? Please select the most fitting answer. 
Note: Respondents were asked to provide only one option. Therefore, each bar represents the share of 
respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

Figure 82. Cessation: reasons for trying to quit small cigarillos (26+ age group) 

 Percentage and number of current users in the 26+ age group who tried to quit 

Base: current users of small cigarillos that tried to quit in the 26+ age group (N=256)  
Question: Q.2.2. What made you try to quit small cigarillos? Please select the most fitting answer. 
Note: Respondents were asked to provide only one option. Therefore, each bar represents the share of 
respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

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The reasons for taking up smoking of small cigarillos again after an attempt to quit are shown in Figure 
83 and Figure 84. What is reported in both age groups looked like the consequence of addiction. In 
the  18-25  age  group  the  reasons  cited  were  ‘stress’  27%,  ‘difficult  to  stop’  19%,  ‘I  had  one  and 
started again’ 20% and ‘I didn’t really want to stop’ 19%. In the 26+ age group the percentages 
reporting these reasons were all marginally higher. 

Figure 83. Reasons for starting to use small cigarillos again (18-25 age group) 

Percentage and number of current users that had attempted to quit in the 18-25 age group 

Base: current users of small cigarillos that tried to quit in the 18-25 age group (N=212)  
Question: Q.2.3. Why did you start to use small cigarillos again? Please select up to 2 options.  
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

Figure 84. Reasons for starting to use small cigarillos again (26+ age group) 

Percentage and number of current users that had attempted to quit in the 26+ age group 

Base: current users of small cigarillos that tried to quit in the 26+ age group (N=256)  
Question: Q.2.3. Why did you start to use small cigarillos again? Please select up to 2 options.  
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

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4.2.3 Parallel use with other tobacco and related products 

Over  90%  of  current  consumers  in  both  age  groups  smoked  small  cigarillos  in  parallel  with  other 
tobacco and related products. Very few transitioned from using another type of tobacco product to 
the exclusive use of small cigarillos, 6% in the 18-25 age group and 7% in the 26+ age group. Only 
1% were never users of other products in the 18-25 age group and 2% in the 26+ age group (see 
Table 34 and Table 35).  

Of  the  330  current  small  cigarillo  users  in  the  18-25  age  group  (see  Table  34),  dual  use  of  other 
tobacco  and  related  products  could  be  more  accurately  described  as  multiple  use.  Almost  all  were 
smoking  conventional  cigarettes  and  high  percentage  smoking  other  tobacco  products.  The  same 
pattern  of  multiple  use  was  seen  in  the  26+  age  group  (see  Table  35)  with  somewhat  lower 
percentages using waterpipe tobacco and HTPs. 

Table 34. Career flows of small cigarillo use for current users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Never user of other products 
Exclusive current user of small cigarillos & past user of other product(s) 

Out of them, switching from (one or more products) *  

Total 

Number  % 
100 
1 
6 

355 
3 
22 

Cigarettes 

Electronic cigarettes 

Waterpipe tobacco  

HTPs 

Slim cigarettes 

(n=18) 

(n=13) 

(n=8) 

(n=8) 

(n=7) 

82% * 

59% * 

36% * 

36% * 

32% * 

Current user of small cigarillos & both current and past user of other product(s)  

330 

93 

Other products consumed in parallel now (one or more products) *  

Cigarettes 

E-cigarettes 

(n=296) 

90% * 

(n=218) 

66% * 

Slim cigarettes 

(n=216) 

65% * 

Waterpipe tobacco 

(n=188) 

57% * 

HTPs 

(n=185) 

56% * 

Base: current users of small cigarillos in the 18-25 age group (N=355);  
Question: Q.1.1. Have you ever used small cigarillos? 
Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  
 (*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 35. Career flows of current small cigarillo users for current users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Never user of other products 
Exclusive current user of small cigarillos & past user of other product(s) 

Out of them, switching from (one or more products) *  

Total 

Number 
429 
8 
32 

% 
100 
2 
7 

Cigarettes 

Slim cigarettes 

Electronic cigarettes  

Waterpipe tobacco  

HTPs 

(n=29) 

(n=8) 

(n58) 

(n=2) 

(n=5) 

91% * 

25% * 

16% * 

6% * 

16% * 

Current user of small cigarillos & both current and past user of other 
product(s)  

389 

91 

Other products consumed in parallel now (one or more products) *  

Cigarettes 

(n=352) 

90% * 

Slim cigarettes 

(n=237) 

61% * 

E-cigarettes 

(n=231) 

59% * 

HTPs 

(n=182) 

47% * 

Waterpipe tobacco 

(n=162) 

42% * 

Base: current users of small cigarillos in the 26+ age group (N=429)  
Question: Q.1.1. Have you ever used small cigarillos? 
Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  
 (*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

The next figures present a visual representation of Table 34 and Table 35 with a focus on dual use 
patterns, hence never users of other products were  excluded from the figures. The thickness of the 
tail is only indicative when interpreting the figure due to double counting (see note below the figure). 
A majority of current small cigarillo users in the 18-25 age group (see Figure 85) were dual users of 
other tobacco and related products. It corroborates the hypothesis that small cigarillos are often used 
for festive occasions. The career flow of current small cigarillo users in the 26+ age group (see Figure 
86) is similar to the younger age group. 

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Figure 85. Representation of career flows for current small cigarillo users (18-25 age group) 

Base:  current  users  of  small  cigarillos  (except  never  users  of  other  products)  in  the  18-25  age  group 
(N=842) 
Question: Q.1.1. Have you ever used small cigarillos? 
Note: The diagram is a simplified version of the career flows of dual current small cigarillo users, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of other 
products (i.e. only used small cigarillos in their lifetime) were excluded. The thickness/width of the tails, 
as well as the percentages included, are only indicative. Some individuals may be represented twice (or 
more) if they use/have used more than one product at a time.  
Source: OE elaboration from online survey data 

Figure 86. Representation of career flows for current small cigarillo users (26+ age group) 

Base:  current  users  of  small  cigarillos  (except  never  users  of  other  products)  in  the  26+  age  group 
(N=1,010)  
Question: Q.1.1. Have you ever used small cigarillos? 
Note: The diagram is a simplified version of the career flows of dual  current small cigarillo users, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of other 
products (i.e. only used small cigarillos in their lifetime) were excluded. The thickness/width of the tails, 
as well as the percentages included, are only indicative. Some individuals may be represented twice (or 
more) if they use/have used more than one product at a time.  
Source: OE elaboration from online survey data 

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Table 36 and Table 37 report the consumption careers of past users of small cigarillos. In the 18-25 
age  group  (see  Table  36),  a  majority  of  former  small  cigarillo  consumers  (61%)  were  consuming 
other tobacco and related products at the time of the survey. Of all past users, 14% had been exclusive 
users of small cigarillos in the past but had switched to using other tobacco products.  

In the 26+ age group (see Table 37), 32% had quit all tobacco use, 15% were exclusive users of 
small cigarillos who had switched to other tobacco products, mainly conventional cigarettes, and 51% 
were dual users in the past who quit small cigarillos and were now dual users of mainly conventional 
cigarettes.  

Table 36. Career flow of past small cigarillo users (18-25 age group) 

Percentage and number of past users in the 18-25 age group 

Never user of other products  

Dual past user & not using any products now 

Total 

Exclusive  past  user  of  small  cigarillos  &  current  user  of  other  products  (but  not 
small cigarillos) 

Out of them, switching to (one or more products) * 

Number 

 % 

536 

100 

13 

122 

76 

2 

23 

14 

Cigarettes 

Electronic cigarettes 

Slim cigarettes 

Waterpipe tobacco 

HTPs 

(n=68) 

(n=36) 

(n=28) 

(n=18) 

(n=15) 

89% * 

47% * 

37% * 

24% * 

20% * 

Dual past user & current user of other products (but not small cigarillos)  

325 

61 

Other products currently consumed in parallel (one or more products) * 

Cigarettes 

E-cigarettes 

HTPs 

Waterpipe tobacco 

Slim cigarettes 

(n=225) 

69% * 

(n=126) 

39% * 

(n=77) 

(n=73) 

(n=63) 

24% * 

22% * 

19% * 

Base: past users of small cigarillos in the 18-25 age group (N=536) 
Question: Q.1.1. Have you ever used small cigarillos? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 37. Career flows of past small cigarillo users (26+ age group) 

Percentage and number of past users in the 26+ age group 

Never user of other products  

Dual past user & not using any products now 

Total 

Exclusive  past  user  of  small  cigarillos  &  current  user  of  other  products  (but  not 
small cigarillos) 

Out of them, switching to (one or more products) * 

Number 

 % 

713 

100 

12 

230 

107 

2 

32 

15 

Cigarettes 

(n=103) 

96% * 

Electronic cigarettes 

Slim cigarettes 

Waterpipe tobacco 

(n=50) 

(n=34) 

(n=23) 

47% * 

32% * 

21% * 

HTPs 

(n=10) 

9% * 

Dual past user & current user of other products (but not small cigarillos)  

364 

51 

Other products currently consumed in parallel (one or more products) * 

Cigarettes 

E-cigarettes 

HTPs 

Slim cigarettes 

Waterpipe tobacco 

(n=252) 

69% * 

(n=180) 

49% * 

(n=113) 

31% * 

(n=81) 

(n=57) 

22% * 

16% * 

Base: past users of small cigarillos in the 26+ age group (N=713)  
Question: Q.1.1. Have you ever used small cigarillos? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

As  previously  explained,  the  figures  below  provide  a  visual  representation  of  dual  product  user 
behaviours.  It  should  be  interpreted  in  the  same  way  as  the  previous  figures.  Many  of  the  former 
consumers of small cigarillos in the  18-25 age group (see Figure 87) and in the 26+ age group 
(see Figure 88) had also been users of other tobacco and related products in the past. But many had 
also switched between products. Overall, the study showed that many users of small cigarillos use the 
product in parallel with another product, i.e. the ‘present’ tail is thicker for current users and the ‘past’ 
tail is thicker amongst past users of the product.  

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Figure 87. Representation of career flows for past small cigarillo users (18-25 age group) 

Base:  past  users  of  small  cigarillos  (excluding  never  users  of  other  products)  in  the  18-25  age  group 
(N=917)  
Question: Q.1.1. Have you ever used small cigarillos? 
Note: The diagram is a simplified version of the career flows of dual past users of small cigarillos, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of other 
products (i.e. only used small cigarillos in their lifetime) were excluded. The thickness/width of the tails, 
as well as the percentages included, are only indicative. Some individuals may be represented twice (or 
more) if they use/have used more than one product at a time.  
Source: OE elaboration from online survey data 

Figure 88. Representation of career flows for past small cigarillo users (26+ age group) 

Base: past users of small cigarillos (excluding never users of other products) in the 26+ age group (N=628) 
Question: Q.1.1. Have you ever used small cigarillos? 
Note: The diagram is a simplified version of the career flows of dual past users of small cigarillos, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of other 
products (i.e. only used small cigarillos in their lifetime) were excluded. The thickness/width of the tails, 
as well as the percentages included, are only indicative. Some individuals may be represented twice (or 
more) if they use/have used more than one product at a time.  
Source: OE elaboration from online survey data 

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4.3  Consumer perception 

Participants  in  the  focus  group  sessions  thought  small  cigarillos  satisfied  emotional  rather  than 
functional  needs.  They  were  viewed  as  old-fashioned  by  many,  which  could  be  either  positive  or 
negative.  Some  believed  it  made  the  product  authentic,  “the  real  thing,”  while  other  viewed  it  as 
“disgusting” due to the strong taste and smell which participants equated to low quality and “rough.” 
For some, the product evoked cosiness and friendliness in a relaxed and easy-going atmosphere. But 
younger participants in Spain associated the product with Farias, an old and low-quality cigar brand. 
In Greece in particular, the focus group found that users of the product differentiated themselves from 
other  tobacco  and  related  product  users  because  the  product  was  not  as  common  as  cigarettes. 
However, it is important to note that few participants were actual users.  

The online survey showed that ‘enjoyment’ and ‘socialising’ were the most cited reasons for starting 
or trying to smoke small cigarillos (e.g. see Figure 75.), which provides an explanation for the more 
intermittent use of the product (see  Figure 64. and Figure 65.). Focus group participants explained 
this pattern of use by clarifying that small cigarillos were often a feature of special occasions.  

“The  cigarette  is  rather  everyday  use  and  then  when  we  are  at  a  party,  we  are  in  a  more 
convivial situation, so we change the way we smoke (and have a small cigarillo).” (F, 53, FR) 

“I don't  associate it so much with smoking as a routine… I associate it  more with something 
you smoke after a meal… I don't see it as  something you would smoke  when you get out of 
work.” (M, 34, ES) 

“My  lung  can't  handle  them.  They've  been  pressed  too  hard  or  I  don't  know.  I  can't  pull  a 
smoke.” (F, 37, DE) 

Focus group participants also described the ritual of consuming small cigarillos as enjoyable and the 
product  as  widely  available.  These  were  motivating  factors  for  the  use  of  the  product.  Participants 
reported that recent developments in the small cigarillo market included the launch of a wide range 
of  flavours  (vanilla,  chocolate,  etc.)  which  could  provide  extra  pleasure  to  the  user  and  encourage 
non-users  to  experiment  with  them.  Flavours  were  mentioned  a  number  of  times  in  the  consumer 
research, such as “masculine” flavours (e.g. brandy) which had recently been launched. There were 
contrasting views in regard to the taste: the satiating character of the product was usually associated 
with masculinity, while many believed the pleasantness came from the milder taste and the aromas.  

“I smoke cigarillos. My favourite brand is Gluk Master, mini. I prefer vanilla. I have tried other 
flavours too. It is not difficult to find them, at least in Sofia. I do experiment, but I like vanilla 
the most.” (F, 42, BG) 

“It gives a good aroma” (M, 36, EL) 

“I associate them (small cigarillos) with flavours.” (F, 42, BG) 

 “I smoke a lot less with this. If I smoked cigarettes, I would need to smoke five to be satisfied 
instead of one of these.” (M, 52, ES) 

“I smoke them because it is milder than a cigarette, it lasts longer, and to me it also  tastes 
better.” (M, 31, ES) 

“Strong and with nasty taste” (M, 24, BG) 

Participants in the group sessions pointed out that the image of the product had historically been one 
of masculinity. The online survey findings supported this image as there were more male than female 
users of small cigarillos, especially in the 18-25 age group (see Table 33). Small cigarillos were usually 
perceived as traditional, basic, old, adult-oriented, and masculine. They were seen to closely resemble 
traditional cigars but of a smaller size, a type of “cheap” cigar that may or may not have a filter. The 

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focus group respondents expected the product to be consumed by adults over the age of 35-40 but 
thought it could also be a gateway product into the tobacco market for younger men.  

“The cigar and cigarillo are traditional.” (F, 53, FR)  

“Cigarillos are more for men; you will not see women.” (F, 27, EL) 

“Nobody wants to smoke from my cigarillos because they are heavy, and they smell. Smell of 
man. The scent is heavy. They have a kind of heavy presence. I like this. […] The classic one, 
with the well-known scent of cigar.” (M, 38, BG) 

Yet, in the online survey, the 18-25 age group appeared to follow a similar pattern as the 26+ age 
group, with 21% of young respondents having already tried the product, as reported in section 4.2.2. 
It suggested that while the belief is that the product is traditional, for older consumers and for males 
exclusively, the results of the online survey paint a different picture. Females appeared to make up a 
considerable  share  in  an  otherwise  male-dominated  market,  and  younger  generations  not  only 
followed a similar pattern of consumption as their older counterparts but also appeared to be starting 
use at younger ages. 

In the online survey users of small cigarillos self-reported socio-economic status (see section 4.2.1). 
In the focus groups the link to cigars and the connection with businesspeople and connoisseurs was 
mentioned - particularly in Bulgaria. The variety of views across focus group sessions may in part be 
due  to  the  prices  of  small  cigarillos  relative  to  cigarettes;  small  cigarillos  can  be  cheaper  or  more 
expensive  than  cigarettes  depending  on  the  country  (see  4.1).  In  the  online  survey,  “economic 
reasons”  were the  second most cited reason  for attempting to quit consuming small cigarillos (see 
Figure 81. and Figure 82.).  

“In more expensive categories (cigars) they are a luxury, but this one is ordinary.” (M, 27, 
EL) 

“(Smoking a small cigarillo) It underlines the fact that something special is going on.” (M, 58, 
EL) 

“Cigarillos  smell,  ok,  cigarettes  have  an  unpleasant,  heavy  smell.  The  cigarillos  I  use,  the 
brandy flavour, smell somewhat good and I need fewer of them.” (M, 36, EL) 

“Cigars  and  cigarillos  are  of  higher  quality,  more  expensive  –  a  metric  for  status  of  the 
consumers. Recently a friend of mine came back from Cuba and brought cigars that are very 
expensive here. This product is something different. You don’t even smoke it, you sense it.” 
(M, 38, BG) 

Furthermore, participants sometimes confused cigars and cigarillos, which could explain the range of 
perceptions regarding the product. Another possibility is that the perception of the product may have 
changed over the years. Companies have put in further  efforts to change the image of the product 
and to promote it as one of luxury.68 Further, with the introduction of the revised TPD which prohibited 
the  production  of  most  flavours  in  cigarettes  and  RYO,  producers  turned  to  using  flavours  in  small 
cigarillos.  

“That is the cigar we have known all our lives; it can just be smaller or bigger.” (F, 54, ES) 

In  the  focus  groups,  small  cigarillos  were  typically  viewed  as  a  more  natural  version  of  cigarettes 
because the product is less processed and wrapped in a tobacco leaf rather than paper. This natural 
image was falsely interpreted as containing less harmful ingredients and as such, overall is was a less 
harmful tobacco product. However, this idea of lower harm decreased when there was no filter.  

68 https://www.simplycigars.co.uk/guide/cigarillos-short-small-2349/  

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Small  cigarillos  were  expected  to  have  higher  levels  of  tar  and  nicotine  than  other  products  under 
study (e.g. e-cigarette) because it is consumed by combustion and has a stronger taste. Nicotine was 
also usually thought to be the substance that provokes the (physical) addiction, but consumers saw 
it as a habit that goes beyond a physical addiction and into a psychological dependence which is much 
more complex. The act of smoking has traditionally been associated with a social activity to meet new 
people and to bond with other users. The ritual around the consumption sometimes made the user 
feel less “addicted” than if they used other tobacco-related products that do not have such a ritual 
(i.e.  snus,  chewing  tobacco  and  sniffing  tobacco).  Furthermore,  small  cigarillos  were  considered  to 
satisfy cravings more thoroughly and therefore are smoked less frequently. 

Similar to the slim cigarettes, small cigarillos were classified as a conventional tobacco product in the 
focus groups; therefore, they were widely recognised as an unhealthy habit which could cause various 
damage and diseases to both consumers and passive consumers. In fact, the main reasons stated by 
focus  group  participants  for  giving  up  or  attempting  to  quit  conventional  tobacco  products  were: 
experiencing some annoying or threatening symptom (e.g. chronic cough, dysphonia or low physical 
performance due to breathlessness); being told to quit by a Doctor; disliking the smell of tobacco; 
feeling  uncomfortable  for  disturbing  others;  or,  to  prevent  eventual  health  problems  over  the  long 
term. Concerns over personal health were also the most stated reason for attempting to quit in the 
online survey. Small cigarillos, just like slim cigarettes, had a tendency to be considered as the most 
harmful products across the present study’s consumer research. 

“They are healthier because they don’t have paper that burns, it's the same tobacco 
leaf.” (M, 52, ES) 

“The slim is worse (than small cigarillos) … that tobacco is rolled in paper which has 
several things we don't know.” (F, 54, ES) 

“I have the impression, because I was smoking both, that it is cleaner, e.g. causes 
less of a problem for lungs than smoking a cigarette.” (M, 36, EL) 

“A colleague of mine smoked  this (small cigarillo), I tried it and I found it better 
than a normal cigarette, so I started smoking it.” (M, 31, ES) 

“You just don’t use it like cigarettes. You inhale cigarettes fully when you smoke, 
while this one you take down to your throat and I believe one should not use it a 
lot because there is some sensitivity afterwards.” (F, 27, EL) 

Figure  89  and  Figure  90  show  the  results  of  the  ‘swing  method’  to  assess  risk  perception  of  small 
cigarillos  and  the  other  tobacco  and  related  products  included  in  this  study  plus  conventional 
cigarettes. The swing method is explained in section 1.3.3. In brief, the respondent is asked which of 
the six products they think is most damaging to a user’s health. This product is given 100 points on a 
scale from 100 (most harmful) to 0 (not harmful). Then using this scale, the respondent is asked to 
rate each of the other five products on its harmfulness to health of users.  

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Overall, the 18-25 year group (see Figure 89) rated the harmfulness to the  users health of small 
cigarillos at 67 out of 100, 15 points lower than conventional cigarettes and about the same as slim 
cigarettes. Current users rated them at 45 compared to never users at 70. 

The 26+ age group (see Figure 90) rated them at 61, 21 point lower than conventional cigarettes. 
The rating for current users was 51 compared to 60 for never users.  

Figure 89. Perceived harmfulness of small cigarillos to users (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.1.a.69 & Q.3.1.b. You have chosen (e.g.; cigarettes, except slims 70) as likely to be the most 
damaging to the health of users. We will give (e.g.; cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g.; cigarettes, except slims), you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
small  cigarillo  user  profiles,  and  therefore  differs  from  the  other  chapter.  The  products  are  sorted  in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

69 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
70 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 90. Perceived harmfulness of small cigarillos to users (26+ age group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910)  
Question: Q.3.1.a.71 & Q.3.1.b. You have chosen (e.g.; cigarettes, except slims 72) as likely to be the most 
damaging to the health of users. We will give (e.g.; cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g.; cigarettes, except slims), you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
small  cigarillo  user  profiles,  and  therefore  differs  from  the  other  chapter.  The  products  are  sorted  in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

71 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
72 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure  91  and  Figure  92  chart  the  perception  of  harmfulness  to  bystanders  through  the  passive 
smoking of small cigarillos. The 18-25 age group (see Figure 91) rated small cigarillos at 67 out of 
100 and posing about the same risk to bystanders as slim cigarettes. Consistent with the findings for 
other tobacco products, current users rated the risk to bystanders at only 48, much lower than never 
users and once  or twice users who  rated the  risk at 70 and 69 respectively. Overall, the 26+ age 
group (see Figure 92) gave a marginally lower assessment than the younger age groups of 63 out of 
100 to the harmfulness of the passive smoking. However, current users rated the risk to bystanders 
at 54 out of 100, some 6 points higher than the younger age group.  

Figure 91. Perceived harmfulness of small cigarillos to bystanders (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.2.a.73 & Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 74) as likely to be the most 
damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points on a scale 
of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the health of 
passive users on a scale of 0 to 100. If you think a product is about half as damaging to the health of 
passive users, you would give it 50 points. But if you think another product is just as damaging as (e.g.; 
cigarettes, except slims), you would give it 100 points 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for small cigarillo user profiles, and therefore differs from the other chapter. The products are 
sorted in descending order of the average score provided by the “group total,” i.e. amongst all respondents 
of that age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

73 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
74 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 92. Perceived harmfulness of small cigarillos to bystanders (26+ age group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.3.2.a.75 & Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 76) as likely to be the most 
damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points on a scale 
of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the health of 
passive users on a scale of 0 to 100. If you think a product is about half as damaging to the health of 
passive users, you would give it 50 points. But if you think another product is just as damaging as (e.g.; 
cigarettes, except slims), you would give it 100 points 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for small cigarillo user profiles, and therefore differs from the other chapter. The products are 
sorted in descending order of the average score provided by the “group total,” i.e. amongst all respondents 
of that age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

75 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
76 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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4.4  Health, social and economic impacts 

While small cigarillos are sometimes considered to be less harmful than regular cigarettes (e.g. see 
section 4.3), this belief is not supported by the scientific evidence. Cigar smoke has been proven to 
contain the same toxic and carcinogenic constituents found in cigarette smoke and can cause oral, 
laryngeal, oesophageal, lung cancer, heart disease, aortic aneurysm, etc. Users often inhale smoke 
from little cigars and cigarillos (Kostygina et al., 2016). Ghosh et al. (2017) examined the biological 
effects of little cigar use and found that it caused significantly greater adverse effects than cigarettes 
(e.g.  on  airway  epithelial  function).  The  online  survey  confirms  other  research  that  small  cigarillos 
were widely used in combination of with other tobacco, particularly cigarettes (Sterling, 2016).  

In terms of social impacts, much of the research specific to cigarillos has been conducted in the USA. 
Cohn (2015, N=1.609) found that a strong but variable association between new tobacco products 
and  alcohol  and  marijuana  use  among  adolescents  (aged  18-24)  in  the  USA.  Alcohol  use  was 
correlated  with  little  cigars  and  cigarillos,  but  to  a  lesser  extent  than  other  tobacco  and  related 
products. By contrast, marijuana use was strongly correlated to little cigars and cigarillos use (Cohn, 
2015).  Studies  have  demonstrated  that  Twitter  was  a  major  information-sharing  and  marketing 
platform for little cigars and cigarillos (Kostygina et al., 2016). The global reach of the internet means 
that impressionable and vulnerable people may be exposed to indirect product promotion or marketing 
practices from outside the EU. 

In the United States, Delnevo (2017, N=909) argued that tobacco manufacturers had responded to 
increased cigarette regulation and taxation by exploiting policy loopholes. The industry offered little 
cigars and filtered cigars as an alternative to cigarettes to be exempt them from regulatory oversight. 
Furthermore, Cantrell et al. (2013, USA) found that the availability, advertising, and price in the point-
of-sale  environment  of  LLCs  encouraged  switching  or  initiation  of  use  in  minority  and  young  adult 
neighbourhoods. The TPD’s restrictions on flavours do not apply to small cigarillos and the TED applies 
a lower tax rate to this product. These measures have already motivated producers to increasingly 
produce  small  cigarillos,  including  those  with  flavours.  The  consumption  patterns  of  potential 
consumers must be closely monitored as it is susceptible to change. It is especially concerning as the 
use of additives as flavouring agents has been established to increase the appeal of tobacco products 
and to veil their harmful potential (DKFZ, 2010).  

In Europe, RAMBOLL (2014) led a study for the Impact Assessment of a possible revision of Council 
Directive  2011/64/EU  on  the  structure  and  rates  of  excise  duty  applied  to  manufactured  tobacco. 
Fourteen  Member  States  reported  that  cigars/cigarillos  were  potentially  attempting  to  abuse  the 
definitions  of  Directive  2011/64/EU  with  the  purpose  of  obtaining  preferential  tax  treatment.  They 
expressed  significant  concern  that  the  preferential  rate  structure  created  substantial  incentives  for 
economic  operators  to  market  products  as  cigarette  substitutes  but  fulfilling  the  minimum 
requirements of the definitions in order to be classified as one with a lower tax rate. While some MS 
expressed concern over the development of “borderline” cigarillos to take advantage of the lower tax 
rates on the cigar and cigarillos,77 other states argued that there was no real demand on the market 
for  this  type  of  product.  However  the  report  also  found  an  increase  in  consumption  of  cigars  and 
cigarillos  between  2008  and  2012,  notably  in  France,  the  UK,  Germany,  Spain  and  Italy.78  A  more 
recent  European  Commission  study  (2017)79  found  that  cigarillos  became  popular  in  some  EU 
countries a few years ago, but have been declining in most EU markets due to a combination of: 

77  Finland,  Germany,  Lithuania,  Latvia,  Slovakia,  Hungary,  the  Netherlands,  Greece,  Portugal,  Czech  Republic,  Spain,  Italy, 
Poland and Sweden.  
78 https://ec.europa.eu/taxation_customs/sites/taxation/files/docs/body/ramboll-tobacco-study.pdf  
79 European Commission (2017): Study on Council Directive 2011/64/EU on the structure and rates of excise duty applied to 
manufactured tobacco 

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  a revised product definition; 
 
 

the end of certain derogations for Germany and Hungary, and 
the adoption, in various countries, of tax structures and rates that reduced the incentives for 
low price products. 

The revision of the definition in 2008 clarified the tax schemes to be applied to this product through 
the predecessor of the current Directive 2011/64/EU (i.e. Directive 2002/10/EU). The Minimum Excise 
Duty  (MED)  is  used  to  refer  to  the  minimum  amount  of  excise  duty  (per  quantity  of  product)  that 
Member States can levy on certain tobacco products when the sum of specific and ad-valorem duties 
falls below an established threshold that is defined nationally. MED consists in a tax  ‘floor’ and was 
designed to prevent the risk  of too low taxation (hence too low prices) and 'race to bottom' in the 
cheaper segments of the market.80 For instance:  

  Germany introduced in 2012 a ‘dynamic’ total tax of 5,760 Cent per piece (minus the VAT of 

the taxed cigar/cigarillo).  

  Denmark more than doubled its fully specific rate between 2014 and 2016 (from € 26.5 to € 

67.0 per 1,000 pieces).  

  Spain introduced a minimum excise duty (MED) of €41.5 per 1,000 units in 2013.  
  Austria increased the MED to €100 per 1,000 pieces in 2013.  
  France switched to a mix structure in 2013, establishing a specific rate  of € 17.5 per 1,000 

pieces in addition to the pre-existing MED.  

These measures were largely effective in closing the regulatory loopholes that had incentivised the 
development of ‘borderline’ cigarillos but there is still a lack of harmonisation between Member States 
(see Figure 175). For instance, small cigarillos were found to be relatively cheaper in Germany than 
in neighbouring countries, which may explain the observed mismatch between consumption and sales 
volumes.  Since  the  Scandinavian  neighbours  tended  to  sell  small  cigarillo  at  a  higher  retail  selling 
prices (RSP), consumers may source themselves in Germany.  

4.5  Concluding remarks on small cigarillos 

This  section  summarises  the  main  findings  that  emerged  from  the  research  conducted  on  small 
cigarillos. The systematic review of secondary sources revealed: 

  Users  often  inhale  smoke  from  small  cigarillos  which  is  expected  to  cause  equal  or  similar 

health problems to conventional cigarettes. 

  According  to  the  Eurobarometer  458  (2017),  the  prevalence  of  regular  and  past  users  of 
cigarillos  remained  relatively  stable  between  2014  and  2017  in  the  EU  –  with  only  3%  of 
respondents  reporting current use  of the product in 2017. The EU market of small cigarillos 
was 2.1 billion euros in 2017, with Germany and France accounting for almost half of the entire 
EU market. 

  Social-networking  sites  have  enabled  indirect  product  promotion,  through  user-generated 

content which influences public opinion on tobacco control policy decisions. 

  Tobacco  companies  have  endeavoured  to  blur  the  distinction  between  little  cigars  and 
conventional  cigarettes  to  take  advantage  of  the  lighter  regulation  of  cigarillos  and  cigars. 
Cigarillos are now flavoured to increase their palatability and appeal, since TPD’s restrictions 
on flavours do not apply to small cigarillos. The industry also circumvents the higher tax rates 
applied  to  cigarettes  by  promoting  a  tax-induced  substitution  of  cigarettes  with  ‘borderline’ 
cigarillos  that  are  taxed  at  a  lower  rate.  The  difference  in  prices  of  small  cigarillos  in  2017 

80 See art14(1a) and (2b) Council Directive 2011/64/EU of 21 June 2011 

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Consumer preference and perception of specific categories of tobacco and related products 

varied by 8-fold between MS with the highest prices (Romania and Croatia) and those with the 
lowest  (Hungary  and  Spain)  (see  Figure  175),  due  to  a  certain  extent  to  the  different  tax 
approaches to cigarillos by MS. 

The empirical research (focus groups and online survey) revealed the following user profile: 

  The average current user of small cigarillo smoked them at least once a week, between 1 and 
5  sticks  every  day  of  use.  Most  users  started  smoking  cigarillos  for  enjoyment.  However, 
socialising was also mentioned. Close to 9 in 10 current cigarillo users are using other tobacco 
and related products concurrently.  

  About 60% of current users had attempted to quit. Among failed quitters, the main reasons to 
try quitting centred on health – personal health, having seen health warnings and the impact 
on passive smokers. The main reason cited for failing to quit was ‘stress’ and ‘difficulty’, in all 
probability responses to addiction. 

  A typical past user used the product at least once a week. Most were dual users of tobacco and 
related products. Past users were divided between those who managed to entirely quit tobacco 
products,  and  those  who  transitioned  to  other  tobacco  products,  mainly  conventional 
cigarettes. Between 60% and 70% of former cigarillo users, depending on the age group, were 
using now other tobacco products, mainly conventional cigarettes. Between 25% and 35% of 
past users had completely quit the use of all the tobacco products.  

Lastly, the following paragraphs highlight the Product and Regulatory perceptions remarks 

  Small  cigarillos  have  traditionally  been  associated  with  masculinity.  However,  this  view  is 
changing  with  more  young  females  using  them.  In  the  focus  groups  cigarillos  were  said  to 
evoke  cosiness  and  friendliness  and  to  be  a  contribution  to  special  occasions  and  social 
gatherings.  Cigarillos  were  also  considered  by  many  as  a  high-class  product  due  to  the 
association with cigars, and as such associated to businesspeople and connoisseurs. They were 
viewed as old-fashioned and authentic, but also “disgusting” due to the strong taste and smell 
by others. The variety of views may in part be due to three factors. First, the prices of small 
cigarillos can be higher or lower than cigarettes, depending on the country. Second, cigarillos 
are  sometimes  confounded  with  cigars.  And  third,  the  tobacco  industry  has  endeavoured  to 
change the image of the cigarillo into a luxury product. 

  Small cigarillos are exempt from the ban on flavours in the revision of the TPD. Such flavours 
have been found to be an appeal to never users, and young people in particular. The online 
survey identified the UK as having the highest share of small cigarillo users (at 11%) in the 
18-25 age group but the highest share of never users (76%) in the 26+ age group. 

  Perception of harmfulness. Small cigarillos, like slim cigarettes, were considered as the most 
harmful products to users and passive across the present study products, after conventional 
cigarettes. Never users perceived cigarillos as much more harmful to both smokers and passive 
smokers. The perception of small cigarillos as less harmful than conventional cigarettes could 
be due to the wrapping in a tobacco leaf rather than paper and therefore perceived as more 
“natural”. Another possibility is that flavouring reduces the perception of risk (see section 4.4).  

  Perception of marketing practices. Participants reported the emergence of flavoured cigarillos.  

  Regulatory support. Cigarillos are recognised as conventional tobacco products.    

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5  Novel tobacco products  

5.1  Background 

There  has  been  a  proliferation  of  novel  tobacco  products  entering  the  EU  market.  Of  particular 
significance  to  the  TPD  are  heated  tobacco  products  (HTPs).  They  have  been  marketed  in  over  40 
countries worldwide as of July 2019 (WHO, 2020), with at least 22 countries from the WHO European 
region (Lugo et al., 2018). In the EU, the brand leader is the Philip Morris IQOS system, comprising 
the IQOS device that heats a tobacco stick called Heetstick.81 It was launched in 2014 in Milan as a 
pilot test for the European market and was expanded to the whole Italian market in 2015 (Lugo et 
al., 2018). In 2017, tobacco companies began aggressive worldwide promotion of HTPs (PMI, 2017). 
As of February 2020, the product was available in 20 Member States.82 In 2018, the WHO published 
an information sheet on HTPs, providing information on how the products were marketed in countries 
where they are available and on the manufactures’ strategies manufacturers to extend their reach to 
other markets.  

Market developments. In this chapter, only heated tobacco products are covered under the ‘novel 
tobacco product’ category. According to the Spanish Ministry of Health (2019, Spain), there is little 
evidence  on  the  use  and  prevalence  of  heated  tobacco  products,  especially  in  Europe.  However, 
several studies have pointed to a rapid rise in consumption and market growth for this product (PHE, 
2018). Figure 93 depicts the structure of the EU market in volume (millions euros) for HTPs according 
to 2017 Passport data.  

Figure 93. Market size of heated tobacco products (HTPs) in million euros in 2017 

Note:  The  market  size  is  estimated  total  sales  in  million  euros  for  2017,  without  population 
adjustments.  It  is  displayed as  a  tree  map  graph  that  consists  of series  of  nested  rectangles  of 
sizes proportional to the corresponding data value. 
Source: OE elaboration of Passport, 2017 

In terms of retail volume, the biggest market for HTPs was Italy, as the first EU country in which the 
product was introduced. Relatively large markets of HTPs were also observed in Romania and Greece. 
Similar findings were reported by the Tobacco Market Commission of the Spanish Ministry of Health 

81 Note there is also currently a new product in some EU countries as well, called glo of British American Tobacco (BAT). 
https://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DOAWUGNJ 
82 https://www.pmi.com/smoke-free-products/iQOS-our-tobacco-heating-system, as of February 2020 

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(2019). In Italy there has been a significant rise in sales of HTPs from sales of 11 tons in 2015 and to 
519 tons in 2017. In Spain, there was also a nine-fold rise in monthly sales between January 2017 
and July 2018. In most Member States HTPs have only recently been available. 

The share of HTPs in the national tobacco markets in 2017 is visually represented for EU markets in 
Figure 94, for countries where data were available.83 The share of HTPs in the national tobacco market 
was particularly high in Romania, Slovakia, Italy, Greece, Slovenia and Portugal. 

Figure 94. Share of HTPs within the national total tobacco market, per country (2017) 

Note:  Percentage  share  of  heated  tobacco  products  were  estimated  with  respect  to  the  whole  tobacco 
market in the country in million euros. 
Source: OE elaboration of Passport, 2017 

Since  younger  generations  are  increasingly  less  likely  to  smoke  conventional  tobacco  products, 
tobacco  companies  have  developed  new  products  which  are  marketed  as  “safer”  alternatives.  Hair 
(2018) reported on the outcomes of expert interviews in which it was said that HTPs appeal to tobacco 
users  because  the  product  is  associated  with  cleanliness,  exclusivity  and  a  high-tech  appearance. 
IQOS  would  be  appealing  to  youth  because  it  would  sit  in  the  “control  space  (cleanliness,  official 
branding, not ‘hackable’ or flexible in terms of flavour).”  

Overall, it is too early to forecast the market developments of HTPs with any accuracy given the large 
variation in market presence across Member States. For example, according to Public Health England 
(PHE), awareness and ever use of heated tobacco products were still rare in Great Britain as of 2017 
(PHE, 2018), while a study in Italy highlighted a rapid increase between 2016 and 2017, although it 
represented only 0.7% of the total market of tobacco products in the country in 2017 (Lugo et al., 
2018). 

83 In this case we used the share of heated tobacco products for the real retail volume and calculated the share in RSP values 
with respect to the whole tobacco market. 

132 

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Consumer perception. Research on the consumer perception of HTPs was limited at the time of this 
study, and most of the available evidence came from industry studies. A study commissioned in the 
UK (PHE, 2018) emphasised the need for evidence on the appeal of HTPs to smokers and non-smokers 
alike, with a particular focus on the appeal to youth. A review conducted by McKelvey et al. (2018) 
found that there are currently no studies on the potential appeal of HTPs appeal to people not using 
any tobacco products.  

HTPs were designed to mimic the behaviour of conventional cigarette smoking without the combustion 
component,  which  has  been  acknowledged  to  be  one  of  the  most  harmful  factors  of  conventional 
tobacco use. According to the WHO, tobacco companies have employed non-traditional marketing and 
product  distribution  strategies  for  the  latest  generation  of  HTPs  to  attract  customers  and  increase 
sales, such as:84 

  Reducing  consumer  health  concerns  through  (uncertain)  claims  that  HTPs  are  reduced-risk 

products. 

  Designing HTP systems to fulfil the role cigarettes once held to boost the user’s social image. 
For  example,  the  IQOS  device  is  available  in  different  colours,  limited  edition  designs  and 
increases consumers’ convenience through reduced odour, rapid charging, and similar features. 
  Employing the “bait and hook” pricing strategy, where a base device (e.g. IQOS device and its 
charging station) is typically sold at a discounted price, with a recurrent price being charged 
for  HTPs  (e.g.  HeetSticks).  This  increases  customer  retention  rates  through  a  discounted 
upfront switching cost and lifetime value of consumers as a result of repeat buying. 

  Using social marketing techniques involving the development of community activists and brand 
ambassadors  who  promote  HTPs  through  various  channels,  ranging  from  individual  and 
community engagement to social media marketing (e.g. social media platforms, promotional 
videos). 

  Advertising by acknowledging the health risks of traditional cigarettes and describing the new 
products as cleaner alternatives, and the shift in tobacco companies’ corporate image towards 
promoting alternative tobacco products. 

  Selling  and  marketing  on  multiple  channels,  including  dedicated  HTP  stores,  retail 

establishments and e-commerce websites. 

The industry has targeted its communication strategy to closely resemble the experience of cigarettes, 
as the sensory characteristic is an important part of the product (WHO, 2019b). The marketing efforts 
were designed to highlight the product as a new concept of traditional smoking, to evoke familiarity 
and nostalgia for smoking. HTP technology – and notably the IQOS system – has become increasingly 
popular in recent years, with tobacco sticks available in multiple flavours (Jankowski et al., 2019). 
Hair (2018) suggested that IQOS had been marketed and advertised with four key message themes: 
cleanliness, customisation, comparisons with combustible smoking and sociability. The analysis of the 
product packaging also identified eight themes specific to the device: clinical purity, a closed system, 
premium  design,  sensory  invitations,  nostalgia  for  combustible  tobacco  smoking,  stability,  familiar 
technology and normalisation. The packaging has been said to resemble iPhones and other high-end 
smartphones, where the device and parts are neatly placed in moulded plastic trays inside a glossy 
white  box  (McKelvey  et  al.,  2018).  There  is  concern  that  this  similarity  in  appearance  to  popular 
electronic devices could increase appeal among younger generations, as the most frequent users of 
such tech-based devices.  

84 https://www.who.int/tobacco/publications/prod_regulation/htps-marketing-monitoring/en/ 

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A pilot study with a small convenience sample (n=60) and a majority of smokers was conducted in 
Italy to validate the SECRHET85 questionnaire on knowledge and behaviours related to cigarettes and 
HTP use among the youth. The data showed that less than half of participants considered HTPs to be 
harmful to the health of users and that 34% would accept one of these products if offered by a friend 
(La Torre et al., 2019). Some findings have suggested that there exists some dissatisfaction with the 
product as a longer-term substitute for smoking over time (WHO, 2019b).  

Impacts.  The  tobacco  industry  has  repeatedly  promoted  HTPs  as  a  less  harmful  and  a  safer 
alternative for conventional tobacco product consumers. There has been considerable debate around 
the absence of combustion and the effects that this product may have on the user and passive users. 
Studies  led  by  the  industry  claimed  a  90%-95%  reduction  in  harmful  and  potentially  harmful 
substances  and  toxicity.86  Other  studies  have  found  other  toxicants  not  present  in  conventional 
cigarettes (e.g. Leigh et al., 2018). Manufacturers have been careful to qualify their claims or include 
a waiver since the research on the health impacts were few and inconclusive (WHO, 2019). As a result, 
both positive and negative information has been circulated. A summary of the impacts is provided in 
section 5.4.  

85 Smoking E-CigaRette and HEat-noT-burn products (SECRHET) 
86https://www.pmiscience.com/resources/docs/default-source/library-
documents/presentation_moira_gilchrist_gtnf_2015a.pdf  

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5.2  Market developments  

5.2.1 Socio-demographic characteristics  

Participants of the focus groups confirmed that the IQOS system was the most well established brand 
in Europe.87 HTPs were usually referred to by the brand name, IQOS, except in France where they 
were also referred to as “tobacco-to-heat” and in Germany where they were called “vaporisers” (as 
with e-cigarettes in the other countries). The  product brand was particularly well viewed in Greece 
because it was said that the government supported Philip Morris due to their substantial investments 
in the country during the economic crisis.  

Figure 95 and  show the use of HTPs across the ten selected EU Member States. Italy, the first country 
to see a European launch, had the highest share of current users (27%) in the 26+ age group. The 
UK, Italy and Bulgaria have double digit percentages (above 10% among the 18-25 age group); and 
Italy, Spain Poland, Greece and Bulgaria in the 26+ age group.  

Figure 95. Use of HTPs: country breakdown (18-25 age group)  

Percentage of all respondents in the 18-25 age group 

Base: all respondents in the 18-25 age group (N=6,090) 
Question: Q.1.1. Have you ever used HTPs? 
Note: The group total category refers to all respondents within the age group. 
Source: OE elaboration from online survey data 

87 In the focus group, HTPs were usually referred to by the brand name of the leader in the market, IQOS, except in France 
where  they  were  also  called  “tobacco  to  heat”  and  in  Germany,  where  they  were  also  referred  to  as  “vaporisers”  (like  e-
cigarettes in the other countries). IQOS was reportedly known to belong to Philip Morris by some participants who thought that 
this company owned the patent. IQOS was particularly well viewed in Greece due to the government propagating that Philip 
Morris had been doing a great investment in the country during the economic crisis. 

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Figure 96. Use of HTPs: country breakdown (26+ age group) 

 Percentage of all respondents in the 26+ age group 

Base: all respondents in the 26+ age group (N=5,910) 
Question: Q.1.1. Have you ever used HTPs? 
Note: The group total category refers to all respondents within the age group.  
Source: OE elaboration from online survey data 

Table 38 and Table 39 present the distributions of some socio-demographic characteristics for the age 
group samples and by HTP user type namely, current user, past user, used once or twice, or never 
used. Among the current users there were marginally more males than females. Current users of HTPs 
in the 26+ age group were much more likely to have a high education level, but not in the 18-25 age 
group in which a percentage of respondents were still in education. Current users were more likely to 
live in urban areas and to consider themselves as having high socio-economic status. Given the recent 
introduction of HTPs they may not have extended their marketing to rural areas, and with an upfront 
cost for the device at circa €40 and the sticks priced at the same as conventional cigarettes, they may 
appeal only to wealthier people.   

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Table 38. HTP use socio-demographic breakdown (18-25 age group) 

Percentage and number of respondents in the 18-25 age group 

Current users 

Past users 

Used once or twice 

Never users 

Group total 
%(n) 

Use of product 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 

(6090) 

47 

(2869) 

53 

(3221) 

5 

(335) 

63 

(3829) 

32 

(1926) 

65 

(3949) 

19 

(1173) 

16 

(968) 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

18 

(1126) 

65 

(3954) 

17 

(1010) 

Self-reported socio-economic status 

% 

8 

10 

7 

% 

7 

9 

6 

13 

10 

8 

9 

9 

8 

5 

8 

7 

7 

8 

8 

8 

5 

6 

7 

% 

16 

17 

14 

17 

16 

15 

17 

15 

13 

14 

16 

16 

% 

69 

64 

73 

60 

70 

68 

66 

70 

77 

73 

70 

58 

14 

12 

Base: all respondents in the 18-25 age group (N=6,090) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data 

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Table 39. HTP use socio-demographic breakdown (26+ age group) 

Percentage and number the of respondents in the 26+ age group) 

Current users 

Past users 

Used once or twice 

Never user 

% 

1111 

% 

6 

% 

1010 

Group total  
% (n) 

Use of product 

Gender 

Male 

Female 

Education level* 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 

(5910) 

52 

(3074) 

48 

(2836) 

5 

(308) 

46 

(2704) 

49 

(2898) 

66 

(3879) 

17 

(1010) 

17 

(1021) 

12 

9 

8 

8 

14 

13 

8 

5 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

23 

(1374) 

64 

(3769) 

13 

(767) 

6 

11 

20 

% 

73 

71 

76 

81 

79 

67 

68 

79 

88 

83 

73 

58 

6 

5 

6 

4 

7 

7 

5 

2 

3 

6 

11 

11 

10 

5 

9 

12 

12 

8 

5 

9 

11 

10 

Base: all respondents in the 26+ age group (N=5,910) 
Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 
Source: OE elaboration from online survey data  

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5.2.2 Pattern of use  

Figure 97 and Figure 98 report the current frequency of use of HTP users. In the 18-25 age group 
57% are daily users and 27% use about once a week. In the 26+ age group, the frequency of use is 
marginally higher with 59% daily users and 31% about once a week. 

Figure 97. Frequency of use of current HTP users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of HTPs in the 18-25 age group (N=503) 
Question: Q.1.3. How often do you use HTPs? 
Source: OE elaboration from online survey data 

Figure 98. Frequency of use of current HTP users (26+ age group) 

Percentage and number of current users in the 26+ age group) 

Base: current users of HTPs in the 26+ age group (N=634) 
Question: Q.1.3. How often do you use HTPs? 
Source: OE elaboration from online survey data 

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The frequency of use among past users is shown in Figure 99 and Figure 100. In both age groups the 
percentage of past daily users was much lower than the current users. In the 18-25 age group, 34% 
were past daily users, 23% fewer than current users. In the 26+ age group the past daily users at 
33% were 26% fewer than current users. 

Figure 99. Frequency of use of past HTP users (18-25 age group) 

Percentage and number of past users in the 18-25 age group 

Base: past users of HTPs in the 18-25 age group (N=446) 
Question: Q.1.6. How often did you use HTPs? 
Source: OE elaboration from online survey data 

Figure 100. Frequency of use of past HTP users (26+ age group) 

Percentage and number of past users in the 26+ age group 

Base: past users of HTPs in the 26+ age group (N=337) 
Question: Q.1.6. How often did you use HTPs? 
Source: OE elaboration from online survey data 

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Figure 101 and Figure 102 report the number of sticks per day of use of HTPs. The two age groups 
report almost identical figures.  In the 18-25 age group 56%  report 1 to 5 sticks and 27% 6 to 10 
sticks. The respective percentages for the 26+ age group were 56% and 17%. 

Figure 101. Average number of HTP sticks a day for current users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of HTPs in the 18-25 age group (N=503) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

Figure 102. Average number of HTP sticks a day for current users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of HTPs in the 26+ age group (N=634) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

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Figure 103 and Figure 104 report the number of sticks per day for the daily users of HTPs. A majority 
of daily users in both age groups reported consuming 6 or more sticks per day. 51% in the 18-25 age 
group of whom 21% used 11 or more sticks a day and 57% in the 26+ age group of whom 25% used 
more than 11 sticks a day.  

Figure 103. Average number of HTP sticks a day, for daily users (18-25 age group) 

Percentage and number of current daily users in the 18-25 age group 

Base: daily current users of HTPs in the 18-25 age group (N=286) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

Figure 104. Average number of HTP sticks a day, for daily users (26+ age group) 

Percentage and number of current daily users in the 26+ age group 

Base: daily current users of HTPs in the 26+ age group (N=374) 
Question: Q.1.4.a. On the days that you smoke/use, about how much do you smoke/use? 
Source: OE elaboration from online survey data 

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HTPs have been on the market for a relatively short time, therefore no starting age trends and duration 
of use could yet be observed (see  

Figure 194 and Figure 195 in the annex). Figure 105 and Figure 106 report the reasons why people 
started to use HTPs. In the 18-25 age group the main reasons were ‘enjoyment’ at 33%, ‘trying to 
quit  or  reduce  consumption  of  another  tobacco  product’  29%,  with  ‘to  socialise/it  was  trendy’  and 
‘tobacco advertisements’ both 20%. Among the 26+ age group ‘trying to quit or reduce consumption 
of another tobacco product’ at 41% was the dominant reason, followed by ‘enjoyment’ 34%, ‘tobacco 
advertisements’ 18% and ‘to socialise/it was trendy’ 17%. For both age groups the industry’s claim 
that HTPs carry lower health risks has made an impact. 

Figure 105. Initiation of HTP use: reasons (18-25 age group) 

Percentage and number of current & past users in the 18-25 age group 

Base: current and past HTP users in the 18-25 age group (N=949)  
Question: Q.2.1.a. Why did you start using HTPs? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

Figure 106. Initiation of HTP use: reasons (26+ age group) 

Percentage and number of current & past users in 26+ age group 

Base: current and past HTP users in the 26+ age group (N=971)  
Question: Q.2.1.a. Why did you start using HTPs? Please select up to 2 options. 

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Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

For those who had used HTPs once or twice, the reasons for trying them are shown in Figure 107 and 
Figure  108.  The  18-25  age  group  reported  experimenting  with  HTPs  for  the  following  reasons 
‘enjoyment’  33%,  ’to  socialise/it  was  trendy’  23%,  and  ‘tobacco  advertisements’  23%.  In  the  26+ 
age group, 33% cited ‘trying to quit or reduce consumption of another tobacco product’, ‘enjoyment’ 
26%, tobacco advertisements 25% and  ‘to socialise/it was trendy’ 18%. A possible explanation for 
some of these reasons was provided by focus group participants. They reported that free trials of HTPs 
offered at points of sales were believed to be a key factor in making the products more user-friendly 
and inviting for new customers. Might the salespersons have promoted HTPs as an aid to healthier 
smoking or an aid to quitting other tobacco products? 

Figure 107. Initiation of HTP use: reasons for trying (18-25 age group) 

Percentage and number of those who tried once or twice in the 18-25 age group 

Base: those who tried to use HTPs in the 18-25 age group (N=955)  
Question: Q.2.1.b. Why did you try HTPs? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from study survey data 

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Figure 108. Initiation of HTP use: reasons for trying (26+ age group) 

Percentage and number of those who tried once or twice in the 26+ age group 

Base: those who tried to use HTPs once or twice in the 26+ age group (N=596)  
Question: Q.2.1.b. Why did you try HTPs? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

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Figure 109 and Figure 110 report on attempts to quit HTPs. The majority of current users reported 
never having attempted to quit HTP use; 62% in the 26+ age group and 51% in the 18-25 age group. 
Among the latter age group 31% had tried to quit more than once, compared to 21% in the older age 
group.  

Figure 109. Cessation: attempts to quit HTPs (18-25 age group) 

 Percentage and number of current users in the 18-25 age group 

Base: current HTP users in the 18-25 age group (N=503)  
Question: Q.1.5. Have you ever tried to quit HTPs? If yes, how many times? 
Source: OE elaboration from online survey data 

Figure 110. Cessation: attempts to quit HTPs (26+ age group) 

 Percentage and number)- of current users in the 26+ age group 

Base: current HTP users in the 26+ age group (N=634)  
Question: Q.1.5. Have you ever tried to quit HTPs? If yes, how many times? 
Source: OE elaboration from online survey data 

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The  reasons  for  trying to  quit  are  shown  in  Figure  111  and  Figure  112.  In  the  18-25  age  group, 
respondents  that  had  attempted  to  quit  reported  doing  so  mainly  due  to  ‘personal  health  reasons’ 
(23%), for ‘economic reasons’ (19%); or due to ‘not liking it anymore’ (18%). Aggregating the reasons 
related to health – personal, health warnings and passive smoking – one in two current users were 
concerned about health issues. In the 26+ age group, current users mainly stated that their attempts 
to quit were motivated by their concern for their ‘personal health’ (24%), the ‘health of others’ (21%) 
and  ‘economic  reasons’  (20%).  While  ‘health  warnings  messages’  were  cited  by  only  10%,  the 
aggregate of health concerns at 55% is marginally higher than the younger age group.  

Figure 111. Cessation: reasons for trying to quit HTP use (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of HTPs that tried to quit in the 18-25 age group (N=247)  
Question: Q2.2. What made you try to quit HTPs? Please select the most fitting answer. 
Note: Respondents were asked to provide only one option. Therefore,  each bar represents the share of 
respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

Figure 112. Cessation: reasons for trying to quit HTP use (26+ age group) 

 Percentage and number of current users in the 26+ age group 

Base: current users of HTPs that tried to quit in the 26+ age group (N=238)  
Question: What made you try to quit HTPs? Please select the most fitting answer. 
Note: Respondents were asked to provide only one option. Therefore, each bar represents the share of 
respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

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Figure 113 and Figure 114 report the reasons why those who tried to quit HTPs started using them 
again. In the 18-25 age group, 27% of current users who had attempted to quit had started consuming 
again on account of ‘stress’. 23% gave in to temptation ‘because I consumed it again on one occasion 
and ended up starting again’ and 22% said it was ‘too difficult to stop’. In the 26+ age group, 25% 
said it was ‘too difficult to stop’ and 25% cited ‘stress’. In both age groups one in five respondents 
cited ‘Because I thought it is not that harmful or that it is healthier than other products’. 

Figure 113. Reasons for starting to use HTPs again (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of HTPs that tried to quit in the 18-25 age group (N=247)  
Question: Q.2.3. Why did you start to use HTPs again? Please select up to 2 options.  
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

Figure 114. Reasons for starting to use HTPs again (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of HTPs that tried to quit in the 26+ age group (N=238)  
Question: Q.2.3. Why did you start to use HTPs again? Please select up to 2 options.  
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

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5.2.3 Parallel use with other tobacco and related products 

Only 1% in both age groups had only ever used HTPs (i.e. never users of other products). In the 18-
25 age group (see Table 40), 14% of current users had switched to HTP use from cigarettes (78%), 
slim cigarettes (64%) and e-cigarettes (31%). Dual use was reported by 84% of current HTP users.  

A similar pattern was reported by the 26+ age group (see Table 41). 12% had switched from other 
tobacco products (85% mentioned conventional cigarettes) and 86% were dual users who, on average 
were using two other products. The most common were cigarettes (85%) and e-cigarettes (66%). 

While HTPs have been advertised as a tool to reduce or quit other tobacco products, it was clear from 
the survey that the actual use of the product did not reflect this purpose, with extensive parallel use 
of HTPs with other tobacco and related products across all consumer groups. Furthermore, it is seen 
from the visual representation that dual use is quite prevalent, as depicted by the thick “present” tail 
(see Figure 196 and Figure 197 in Annex). 

Table 40. Career flows of use for current HTP users (18-25 age group) 

Percentage and number of current users in the 18-25 age group)  

Never user of other products 
Exclusive current user of HTP & past user of other product(s) 
Out of them, switching from (one or more products) *  

Total 

Cigarettes 

Slim cigarettes 

E-cigarettes 

Waterpipe tobacco 

Small cigarillos 

(n=57) 

(n=47) 

(n=23) 

(n=22) 

(n=10) 

78% * 

64% * 

31% * 

30% * 

14% * 

Number  % 
100 
1 
14 

503 
5 
73 

Current user of HTP & both current and past user of other product(s)  

425 

84 

Other products consumed in parallel now (one or more products) *  

Cigarettes 

E-cigarettes 

Slim cigarettes 

Waterpipe tobacco 

Small cigarillos 

(n=348) 

(n=277) 

(n=228) 

(n=219) 

(n=185) 

82% * 

65% * 

54% * 

52% * 

44% * 

Base: current users of HTPs in the 18-25 age group (N=503);  
Question: Q.1.1. Have you ever used HTPs? 
Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 41. Career flows of current HTP users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Never user of other products 
Exclusive current user of HTP & past user of other product(s) 
Out of them, switching from (one or more products) *  

Total 

Cigarettes 

Slim cigarettes 

E-cigarettes 

Small cigarillos 

Waterpipe tobacco 

(n=72) 

(n=25) 

(n=13) 

(n=12) 

(n=7) 

91% * 

32% * 

16% * 

15% * 

9% * 

Number  % 
100 
1 
12 

634 
7 
79 

Current user of HTP & both current and past user of other product(s)  

548 

86 

Other products consumed in parallel now (one or more products) *  

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

Waterpipe tobacco 

(n=466) 

(n=362) 

(n=251) 

(n=125) 

(n=182) 

85% * 

66% * 

46% * 

33% * 

33% * 

Base: current users of HTPs in the 26+ age group (N=634)  
Question: Q.1.1. Have you ever used HTPs? 
Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 42 and Table 43 report the career flow for past HTP users. In the 18-25 age group (see Table 
42),  very  few  (1%)  of  the  former  users  had  only  ever  tried  HTP  and  no  other  tobacco  and  related 
products: 23% were past dual users who reported that they had now quit using any tobacco products 
and 13% reported having used only HTP in the past and switched to other products. These findings 
point  to  the  gateway  potential  of  HTPs  for  other  tobacco  products.  Most  of  these  respondents  had 
switched to conventional cigarettes (61%) with around 40% taking up slim cigarettes, e-cigarettes or 
waterpipe tobacco after quitting HTP use: 64% of past dual users who reported quitting HTP were now 
using conventional cigarettes (71%) and about 3 in 10 reported using e-cigarettes or slim cigarettes.  

In the 26+  age  group (see Table 43), 18%  of past users were no longer  consuming any tobacco 
products. Of the 13% that had used HTP only in the past and had transitioned to other products, 89% 
had  switched  to  conventional  cigarettes  and  59%  to  e-cigarettes.  66%  of  past  HTP  users  reported 
continued dual use of conventional cigarettes (72%) and e-cigarettes (50%). It is important to note 
that while the above percentages are high, the absolute numbers are quite low.  

Table 42. Career flow of past HTP users (18-25 age group) 
Percentage and number of past users in the 18-25 age group 

d 

Total 

Never user of other products  

Dual past user & not using any products now 

Exclusive past user of HTPs & current user of other products (but not HTPs) 

Out of them, switching to (one or more products) * 

Number 

 % 

446 

100 

3 

101 

57 

1 

23 

13 

Cigarettes 

Slim cigarettes 

E-cigarettes 

Waterpipe tobacco 

Small cigarillos 

(n=35) 

(n=24) 

(n=24) 

(n=20) 

(n=11) 

61% * 

42% * 

42% * 

35% * 

19% * 

Dual past user & current user of other products (but not HTPs)  

285 

64 

Other products currently consumed in parallel (one or more products) * 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Waterpipe tobacco 

Small cigarillos 

(n=201) 

(n=97) 

(n=80) 

(n=64) 

(n=40) 

71% 

34% 

28% 

22% 

14% 

Base: past users of HTPs in the 18-25 age group (N=446)  
Question: Q.1.1. Have you ever used HTPs? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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Table 43 Career flows of past HTP users (26+ age group) 
Percentage and number of past users in the 26+ age group 

Never user of other products  

Dual past user & not using any products now 

Total 

Exclusive past user of HTPs & current user of other products (but not HTPs) 

Out of them, switching to (one or more products) * 

Number 

 % 

337 

100 

3 

57 

56 

1 

17 

17 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

Waterpipe tobacco 

(n=50) 

(n=33) 

(n=18) 

(n=12) 

(n=5) 

89% * 

59% * 

32% * 

21% * 

9% * 

Dual past user & current user of other products (but not HTPs)  

221 

66 

Other products currently consumed in parallel (one or more products) * 

Cigarettes 

E-cigarettes 

Slim cigarettes 

Small cigarillos 

Waterpipe tobacco 

(n=159) 

72% * 

(n=110) 

50% * 

(n=59) 

(n=42) 

(n=38) 

27% * 

19% * 

17% * 

Base: past users of HTPs in the 26+ age group (N=337)  
Question: Q.1.1. Have you ever used HTPs? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is 
the variable of interest; it does not include a breakdown that takes account past consumption of products 
to avoid confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use. 
Source: OE elaboration from online survey data 

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5.3  Consumer perception 

In the focus groups discussions HTPs were the least known of the products featured in this study and 
there was some confusion between HTPs and the electronic cigarette, as both were considered non-
conventional tobacco products, requiring an electronic device.  

Table 44 and Table 45 focus on where the survey respondents first saw or heard about HTPs. In the 
18-25  age  group,  36%  reported  hearing  about  the  product  from  friends  and  family,  14%  from 
marketing in shops and tobacco stores, 12% from social media and 10% from product promotions in 
stores, stations or airports. In the 26+ age group friends and family were the primary source for 37%, 
followed by marketing in shops and tobacco stores (17%). 

Table 44. Perception of HTPs (18-25 age group) 

Percentage and number of respondents in the 18-25 age group 

Use of product 

Facebook, Instagram or other social 
media networks  
Other online advertisement  

Traditional media (print, TV, radio, 
billboards) 
Marketing in shops or tobacco stores 

Observed in the street  

Friends and family 

Product promotions in stores, stations or 
airports etc.  
Other 

Group 
total 

% (n) 
100 
(4167) 
12 
(487) 

7 
(274) 
7 
(300) 

14 
(598) 
13 
(538) 
36 
(1492) 
10 
(398) 

2 
(80) 

Current 
users 

Past 
users 

Used once or 
twice 

Never 
used 

% 
12 

15 

16 

14 

12 

11 

10 

16 

12 

% 
11 

15 

11 

9 

10 

10 

8 

15 

11 

% 
23 

20 

26 

23 

23 

21 

23 

27 

21 

% 
54 

49 

47 

54 

55 

58 

59 

42 

55 

Base: respondents in the 18-25 age group that had heard of HTPs prior to the survey (N=4,167) 
Question: Q4.2. Where did you first see or hear about heated tobacco products (e.g. iQOS, glo)? [SINGLE 
ANSWER]  
Note:  The  group  total  column  refers  to  all  respondents  within  the  age  group,  i.e.  it  is  a  within  column 
percentage. It provides the breakdown of the response options (e.g. 12% of respondents in this age group 
first saw or heard about HTPs through Facebook, Instagram or other social media networks). The white 
cells (in the four right columns) represent the breakdown by user type, i.e. they are within row percentages 
(white cells in each row sum to 100). 
Source: OE elaboration from online survey data 

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Table 45 Perception of HTPs (26+ age group)  

Percentage and number of respondents in the 26+ age group 

Use of product 

Facebook, Instagram or other 
social networks  
Other online advertisement  

Traditional  media  (print,  TV, 
radio, billboards) 
Marketing in shops or tobacco 
stores 
Observed in the street  

Friends and family 

Product  promotions  in  stores, 
stations or airports etc.  
Other 

Group 
total 

% (n) 
100 

6 
(243) 

8 
(296) 
10 
(366) 

17 
(633) 

11 
(399) 
37 
(1384) 
10 
(384) 

2 
(74) 

Current 
users 

% 
11 

26 

19 

14 

19 

15 

15 

19 

5 

Past users 

% 

6 

10 

9 

9 

10 

11 

8 

10 

5 

Used once 
or twice 

% 
10 

12 

16 

16 

16 

10 

17 

21 

16 

Never used 

% 

73 

51 

56 

61 

55 

65 

61 

51 

73 

Base: respondents in the 26+ age group that had heard of HTPs prior to the survey (N=3,779) 
Question: Q4.2. Where did you first see or hear about heated tobacco products (e.g. iQOS, glo)? [SINGLE 
ANSWER]  
Note:  The  group  total  column  refers  to  all  respondents  within  the  age  group,  i.e.  it  is  a  within  column 
percentage. It provides the breakdown of the response options (e.g. 6% of respondents in this age group 
first saw or heard about HTPs through Facebook, Instagram or other social media networks). The white 
cells (in the four right columns) represent the breakdown by user type, i.e. they are within row percentages 
(white cells in each row sum to 100). 
Source: OE elaboration from online survey data  

From  the  focus  group  discussions  eight  words  or  word  combinations  that  people  used  to  describe 
tobacco and related products were selected; four were positive associations and four negative. The 
associations  were  complicated,  unhealthy,  costly,  addictive,  practical,  modern/technological, 
elegant/trendy/fashionable and enjoyable.  

In  the  online  survey  respondents  were  asked  which  of  the  words  best  captured  what  they  thought 
about HTPs. The results are shown in Table 46 and Table 47. For the 18-25 age group as a whole 
the  most  frequent  associations  with  HTPs  were  ‘unhealthy’  43%,  ‘modern  and  technological’  41%, 
costly 31%, and ‘elegant, trendy, fashionable’ 26%. The 26+ age group selected a very similar list 
of associations ‘unhealthy’ 45%, ‘modern and technological’ 36%, costly 30%, and ‘elegant, trendy, 
fashionable’ 21%.  

Current  users,  particularly  those  in  the  26+  age  group  selected  more  positive  associations. 
Unsurprisingly,  they  were  overrepresented  in  the  group  of  respondents  that  selected  the  term 
‘enjoyable’ to describe HTPs.  

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Table 46. Perception of the HTPs (18-25 age group) 

Percentage and number of respondents in the 18-25 age group 

Use of product 

Complicated 

Unhealthy 

Costly 

Addictive 

Practical 

Modern/technological 

Group 
total 

% (n) 

100 

(6090) 

11 

(688) 

43 

(2644) 

31 

(1892) 

33 

(1995) 

19 

(1138) 

41 

(2506) 

Elegant/trendy/fashionable 

26 

Enjoyable 

(1591) 

11 

(655) 

Current 
users 

Past users 

% 

Used once 
or twice 

Never 
used 

% 

8 

8 

3 

6 

5 

14 

8 

11 

24 

7 

6 

4 

6 

5 

11 

7 

9 

12 

% 

16 

15 

12 

15 

13 

19 

16 

21 

20 

% 

69 

72 

80 

73 

77 

56 

69 

59 

44 

Base: respondents in the 18-25 age group (N=6,090) 
Question Q.4.4. Which of the following words best captures what you think about heated tobacco products 
(e.g. iQOS, glo)? Please tick as many boxes as you would like.  
Note: Respondents had the option to choose as many terms as they wanted. The group total column refers 
to all respondents within the age group, i.e. it is a within column percentage, e.g. 11% of respondents 
perceived the product as complicated. The white cells (in the four right columns) represent the breakdown 
by user type, i.e. they are within row percentages (white cells in each row sum to 100). 
Source: OE elaboration from online survey data 

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Table 47 Perception of HTPs (26+ age group) 

Percentage and number of respondents in the 26+ age group 

Use of product 

Complicated 

Unhealthy 

Costly 

Addictive 

Practical 

Modern/technological 

Elegant/trendy/fashionable 

Enjoyable 

Group 
total 

% (n) 

100 

(5909) 

13 

(767) 

45 

(2646) 

30 

(1799) 

33 

(1962) 

16 

(941) 

36 

(2155) 

21 

(1266) 

10 

(585) 

Current 
users 

% 

11 

5 

3 

7 

6 

27 

15 

18 

34 

Past users 

% 

6 

5 

3 

6 

5 

8 

5 

8 

14 

Used once 
or twice 

Never 
used 

% 

10 

10 

7 

12 

8 

13 

12 

15 

14 

% 

73 

81 

87 

76 

82 

52 

68 

59 

38 

Base: respondents in the 26+ age group (N=5,909) 
Question Q.4.4. Which of the following words best captures what you think about heated tobacco products 
(e.g. iQOS, glo)? Please tick as many boxes as you would like.  
Note: Respondents had the option to choose as many terms as they wanted. The group total column refers 
to all respondents within the age group, i.e. it is a within column percentage, e.g. 13% of respondents 
perceived the product as complicated. The white cells (in the four right columns) represent the breakdown 
by user type, i.e. they are within row percentages (white cells in each row sum to 100). 
Source: OE elaboration from online survey data 

The focus group sessions took the position that although HTPs conveyed a  stylish, exclusive, adult-
like and futuristic image, but the hype around this product was believed to be temporary.  

“The IQOS is the trendiest one and I think it’s a product that is mainly consumed 
by  people  who  want  to  be  trendy  and  I  associate  the  pink  IQOS  with  the  pink 
iPhone.” (M, 28, BG) 

“They are very trendy. People buy them for gifts.” (F, 43, BG) 

“It’s rather a fashion. Or a substitute for people who work in offices and do not have 
breaks.” (M, 24, BG) 

“I bought the e-cigarette and the IQOS because I saw them in the tobacconist, and 
they looked very cute and nice.” (F, 54, ES) 

“Most of the people, 80  – 90% who smoke IQOS smoke cigarettes too and won’t 
stay with the IQOS only.” (F, 25, BG) 

Participants in the focus groups did not expect HTPs to be particularly appealing to non-smokers but 
rather  only  to  experienced  adult  smokers.  HTPs  allowed  for  the  nostalgia  of  conventional  tobacco 
products without some of the disadvantages associated with traditional cigarettes. 

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“Well, it is innovative. It is different from all the rest… It is different because you 
are still smoking a cigarette, not a vaper.” (F, 54, ES) 

“What convinced me was the fact that it is real tobacco. It’s important because that 
way the flavour and the satisfying effect are greater.” (M, 32, ES) 

“This  one  (IQOS)  contains  the concept  of  cigarettes,  in  the sense  that  there  is  a 
device but what reaches your mouth is something of a reminder of cigarettes. It is 
the filter, etc.” (M, 26, EL) 

“It  remains  a  cigarette  and  I  tasted  this  cigarette  and  it’s  true  that  we  have  the 
same sensations that we do with a normal cigarette. Which is something I cannot 
find with the electronic cigarette! It’s a way of smoking that is completely different.” 
(F, 49, FR) 

“Smokers might use it to avoid stinking up the room.” (F, 27, EL) 

The focus groups commented on the marketing tactics of the industry which had been to promote the 
product as an experience a close to cigarette smoking and to convey an image of a sophisticated and 
innovative  product  for  users.  The  heated  tobacco  stick  contains  “real”  tobacco  and  conventional 
tobacco consumers considered HTPs as a more suitable substitute than other products (notably, e-
cigarettes).  However,  overall  participants  did  not  believe  that  it  was  as  satisfying  as  conventional 
tobacco  products.  Rather  it  was  experienced  as  “colder”  emotionally  speaking.  It  was  repeatedly 
reported as bothersome and/or frustrating because the battery required charging, so that users might 
not have the product topped up when the craving strikes. These features were off-putting for some 
participants in the focus groups.  

“I don’t find it elegant at all. Personally no, frankly it already seems impractical to 
prepare and I can’t see what occasion this could be used in, I don’t know.” (F, 66, 
FR) 

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Figure 115 and Figure 116 report the survey respondents’ opinions on the ‘gateway’ potential of HTPs. 
In the 18-25 age group, 66% agreed that HTPs might definitely or probably encourage people to start 
smoking other tobacco products, compared to 23% who thought it would probably or definitely not. 
60% of the 26+ age group held a similar view on the gateway effect with 23% disagreeing. 

Figure 115. Perceived gateway effect of HTPs (18-25 age group)  
Percentage and number of the 18-25 age group 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q4.3. Do you think using heated tobacco products (e.g. iQOS, glo) might encourage people to 
start smoking/using other tobacco products, or not? [SINGLE ANSWER] 
Source: OE elaboration from online survey data 

Figure 116 Perceived gateway effect of HTPs (26+ age group) 
Percentage and number of the 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question: Question: Q4.3. Do you think using heated tobacco products (e.g. iQOS, glo) might encourage 
people to start smoking/using other tobacco products, or not? [SINGLE ANSWER] 
Source: OE elaboration from online survey data 

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Figure  117  and  Figure  118  report  the  survey  respondents  on  whether  HTPs  would  be  attractive  to 
young people. In the 18-25 age groups 70% said probably or definitely yes. 22% took the opposite 
view. Much the same opinion was held by the 26+ age group. 66% said probably or definitely yes, 
HTP would be attractive to young people; 20% had the opposite view. 

Figure 117 Perceived appeal of HTPs to youth (18-25 age group)  

Percentage and number of 18-25 age group 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.5. Do you think that young people might be particularly attracted to heated tobacco products 
(e.g. iQOS, glo), or not? [SINGLE ANSWER] 
Source: OE elaboration from online survey data 

Figure 118 Perceived appeal of HTPs to youth (26+ age group)  
Percentage and number of 26+ age group  

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.5. Do you think that young people might be particularly attracted to heated tobacco products 
(e.g. iQOS, glo), or not? [SINGLE ANSWER] 
Source: OE elaboration from online survey data 

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A  rather  different  picture  from  the  focus  groups  emerged.  The  focus  groups  did  not  see  this  as  a 
concern as HTPs were considered too expensive (except in Germany) as there was a charge for both 
the  device  and  the  heated  tobacco  sticks.  (e.g.  IQOS  device  and  HeetSticks).  On  this  basis  the 
participants did not expect the product to become popular, especially among the younger people. The 
participants  believed  that  the  product  would  fail  to  interest  this  age  group  due  to  its  price  and 
perceived  exclusive  character.88  Rather,  participants  associated  the  product  with  adults  and/or 
professionals between the ages of 25 and 50.  

“I think price could play a role on the last one (IQOS). (…) the heat not burn tobacco 
is quite expensive…” (M, 28, FR)  

“If after a year or two, I tell myself that I’m sick of smoking and want to stop then 
I will get an e-cigarette again. It will certainly not be that heat not burn ones just 
because of the price.” (M, 20, FR) 

Figure  119  and  Figure  120  look  at  another  concern  about  young  people,  that  they  are  inclined  to 
misperceive the risk of smoking. The survey respondents were asked “Do you think that young people 
might underestimate the risk of consuming heated tobacco products”. The figures depict a widespread 
consensus across both age groups. In the 18-25 age group, 77% agree that young people probably 
or definitely underestimate the risk of consuming HTPs and 18% said that young people probably or 
definitely do not underestimate the risk (see Figure 119). The respective percentages in the 26+ age 
group at 76% and 16% (see Figure 120). 

Figure 119 Extent to which respondents believed that youth underestimated risks of using HTPs 

Percentage and number of respondents in the 18-25 age group 

Base: respondents in the 18-25 age group (N=6,090) 
Question:  Q.4.6.  Do  you  think  that  young  people  might  underestimate  the  risk  of  consuming  heated 
tobacco products (e.g. iQOS, glo), or not? [SINGLE ANSWER]  
Source: OE elaboration from online survey data 

88 Note that this is only the perception of focus group participants and that this study’s fieldwork did not cover those under the 
age of 18.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 120 Extent to which respondents believed that youth underestimate risks of HTPs 
Percentage and number of 26+ age group) 

Base: respondents in the 26+ age group (N=5,910) 
Question:  Q.4.6.  Do  you  think  that  young  people  might  underestimate  the  risk  of  consuming  heated 
tobacco products (e.g. iQOS, glo), or not? [SINGLE ANSWER]  
Source: OE elaboration from online survey data 

On the issue of the health risks of HTPs the  focus group participants commented on the unhealthy 
characteristics of the product but also acknowledged that long-term effects were still unknown. Some 
believed that HTPs may be as harmful as conventional tobacco products because they also contain 
tobacco and paper (as well as the plastic filter); others thought that HTPs might lead to different types 
of  harm  due  to  new  harmful  substances.  Participants  were  also  concerned  about  the  environment 
because HTPs contain tobacco, papers and plastic filters which may also pollute the environment like 
conventional cigarettes.  

“Maybe the fact that we do not burn the tobacco makes it less harmful.” (F, 49, FR) 

“IQOS because it is heated does not bring out the tar, I know this.” (M, 58, EL) 

“IQOS. In my view, this is the most harmful product among all we are reviewing... 
I have friends who have made a research. And I have unwrapped such a cigarette 
and have studied it before and after smoking. The filter inside is made of nylon and 
melts  during  smoking.  I  think  the most  harmful  effects  come  from  this.”  (M,  24, 
BG) 

“For  me  IQOS  is  the  least  harmful  because  you  do  not  inhale  smoke  and  solid 
particles.  And  when  I  smoke  more  IQOS  I  feel  better  than  when  I  smoke 
conventional cigarettes.” (F, 25, BG) 

“I have heard that it (IQOS) has become legal and that it is healthy and has some 
certification in contrast to the electronic cigarette.” (F, 27, EL) 

“It’s not natural (e-cigarette) so we try to go backwards with the heated tobacco 
because the tobacco is natural” (F, 49, FR) 

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Another view was that heated tobacco sticks may be less harmful than conventional tobacco products 
because  they  are  not  burned  but  rather  heated  with  no  combustion  and  no  smoke.  The  use  of  an 
electronic device was perceived as more up to date and that people might assume it was healthier 
and research and development of the industry should deliver better products over time – not worse. 
In general, participants were unsure about the working of HTPs (e.g. whether it is vapour or smoke 
that is inhaled), but most believed that the product was not completely harmless, and they expected 
it to be addictive given the presence of nicotine. 

“We already know that what is bad about the cigarette is the combustion! Well, at 
least that is what is worst about it.” (M, 28, FR)  

“It  resembles  an  e-cigarette.  But,  from  what  was  said,  the e-cigarette  was  great 
because it took away all the harmful things of tobacco. And there (the HTP), not at 
all. We still have tobacco and we have no hindsight at all. It’s just a new gimmick.” 
(F, 48, FR) 

“IQOS is a technology with no direct burning, with lower temperature, producing 
less harmful substances.” (M, 28, BG) 

In the online survey the swing methodology was employed to assess the relative harmfulness to users 
of  HTP  compared  to  the  other  products  considered  in  this  study  plus  conventional  cigarettes.  The 
swing method is explained in section 1.3.3. In brief, the respondent is asked which of the six products 
they think is most damaging to a user’s health. This product is given 100 points on a scale from 100 
(most harmful) to 0 (not harmful). Then using this scale, the respondent is asked to rate each of the 
other five products on its harmfulness to health of users.  

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Figure 121 and Figure 122 show the perceived harmfulness to the health of HTP users. In the 18-25 
age group conventional cigarettes were considered most harmful with a rating of 82. HTPs were rated 
at 58. Current users of HTPs rated them at 44 and never users at 61. While respondents in both age 
groups thought that young people might underestimate the risks of HTPs , when asked directly about 
the harm to users’ health the 18-25 age group (see Figure 121) perceived HTPs as more harmful than 
the 26+ age group (see Figure 122). A heightened view of the health risk was also evident among 
users of HTPs in the 18-25 age group. 

Figure 121. Perceived harmfulness of HTPs to users (18-25 age group)  

average score 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.1.a.89 & Q.3.1.b. You have chosen (e.g.; cigarettes, except slims 90) as likely to be the most 
damaging to the health of users. We will give (e.g.; cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g.; cigarettes, except slims), you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
HTP  user  profiles,  and  therefore  differs  from  the  other  chapter.  The  products  are  sorted  in  descending 
order of the average score provided by the “group total,” i.e. amongst all respondents of that age group. 
The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

89 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
90 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 122. Perceived harmfulness of HTPs to users (26+ age group)  

average score 

Base: respondents in the 26+ age group (N=5,910)  
Question: Q.3.1.a.91 & Q.3.1.b. You have chosen (e.g.; cigarettes, except slims 92) as likely to be the most 
damaging to the health of users. We will give (e.g.; cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g.; cigarettes, except slims), you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. For this chapter, the breakdown is provided for 
HTP  user  profiles,  and  therefore  differs  from  the  other  chapter.  The  products  are  sorted  in  descending 
order of the average score provided by the “group total,” i.e. amongst all respondents of that age group. 
The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

91 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
92 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

164 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure  123  and  Figure  124  report  on  the  perceived  harm  of  HTPs  to  bystanders.  In  the  18-25  age 
group, the passive  smoking risk from HTPs was  rated lower than conventional and slim cigarettes, 
and  small  cigarillos  and  above  waterpipe  tobacco  and  e-cigarettes.  The  26+  age  group  showed  a 
similar ordering of the perceived harm of passive smoking. As with the risk to the health of users, the 
18-25 age group rated the passive smoking risk higher (52) than the 26+ age group (45). 

Figure 123. Perceived harmfulness of HTPs to bystanders (18-25 age group) 

average score 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.2.a.93 & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 94) as likely to be 
the most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims), you would give it 100 points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for HTP user profiles, and therefore differs from the other chapter. The products are sorted in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

93 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
94 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 124. Perceived harmfulness of HTPs to bystanders (26+group)  

average score 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.3.2.a.95 & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 96) as likely to be 
the most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims), you would give it 100 points.  
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the passive user 
provided by respondents for products under the scope of this study. For this chapter, the breakdown is 
provided for HTP user profiles, and therefore differs from the other chapter. The products are sorted in 
descending order of the average score provided by the “group total,” i.e. amongst all respondents of that 
age group. The dotted orange box identifies the product in focus.  
Source: OE elaboration from online survey data 

On  the  issue  of  regulation,  the  focus  groups  were  clear  that  HTP  should  be  regulated  as  other 
conventional tobacco products. They noted that HTPs contained tobacco and as such should be taxed 
accordingly. The online survey results confirmed these qualitative insights. Figure 125 and Figure 126 
report the survey respondents’ views on whether HTPs should be regulated like cigarettes or not: 74% 
of  the  18-25  age  groups  responded  probably  (44%)  or  definitely  (30%)  yes.  79%  of  the  26+  age 
group said yes, definitely (48%) and probably (31%). Overall, a public endorsement for the regulation 
of HTPs. 

95 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
96 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 125. Extent of agreement with regulating HTPs like cigarettes (18-25 age group)  

Percentage and number of 18-25 age group 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.7. Do you think that heated tobacco products should be regulated like cigarettes, or not? 
[SINGLE ANSWER] 
Source: OE elaboration from online survey data 

Figure 126. Extent of agreement with regulating HTPs like cigarettes (26+ age group)  

Percentage and number of 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.7. Do you think that heated tobacco products should be regulated like cigarettes, or not? 
[SINGLE ANSWER] 
Source: OE elaboration from online survey data 

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Table 48 and Table 49 report on the locations where the use of HTPs should be allowed or restricted. 
A wide range of views from the very highly restrictive to the libertarian were evidenced. But the weight 
of opinion for both age groups was that HTP should not be allowed at work, on public transport and 
in restaurants and bars. 

Table 48. Views on settings where HTPs should be prohibited (18-25 age group) 

 Percentage and number of respondents in the 18-25 age group 

Use of product 

Open  outdoor  spaces  (e.g.  bus  stops, 
playgrounds) 

Work 

Public transport 

Restaurants/ bars indoors 

Restaurants/ bars outdoor terraces 

Private transportation 

All of the above 

None 

Other 

Group 
total 

% (n) 

100 
(6090) 

23 
(1429) 

51 
(3119) 

63 
(3808) 

56 
(3308) 

18 
(1078) 

32 
(1935) 

10 
(620) 

7 
(400) 

3 
(172) 

Current 
users 

Past 
users 

% 

8 

8 

5 

6 

5 

7 

5 

3 

13 

8 

% 

7 

6 

6 

6 

6 

7 

5 

4 

6 

7 

Used 
once or 
twice 

% 

16 

14 

14 

15 

15 

13 

14 

10 

17 

12 

Never 
used 

% 

69 

72 

74 

73 

74 

73 

76 

83 

64 

73 

Base: respondents in the 18-25 age group (N=6,090) 
Question:  Q.4.14.  In  which  settings,  if  any,  do  you  think  that  the  consumption  of  HTPs  should  be 
prohibited? 
Note:  Respondents  could  provide  multiple  answers,  except  if  they  selected  “All  the  above”  or  “None”. 
Hence, a special consideration must be made when analysing the responses. Although 23% reported “open 
outdoor spaces”, 33% of respondents in the age group were in favour of prohibiting product use in open 
outdoor spaces (i.e. 23% + 10% that answered “all of the above”). The group total category refers to the 
total respondents in that age group. The orange column represents the proportion of respondents in the 
age group that selected the response option (i.e. 3% of respondents in the 18-25 age group responded 
“other”). The white cells (in the four right columns) represent the breakdown by user type, i.e. they are 
within row percentages (white cells in each row sum to 100).  
Source: OE elaboration from online survey data 

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Table 49. Views on settings where HTPs should be prohibited (26+ age group)  

Percentage and number of respondents in the 26+ age group) 

Reasons 

Use of product 

Open  outdoor  spaces  (e.g.  bus  stops, 
playgrounds) 

Work 

Public transport 

Restaurants/ bars indoors 

Restaurants/ bars outdoor terraces 

Private transportation 

All of the above 

None 

Other 

Group 
total 

% (n) 

100 
(5910) 

22 
(1296) 

53 
(3133) 

62 
(3661) 

54 
(3198) 

18 
(1088) 

30 
(1755) 

16 
(921) 

8 
(484) 

1 
(88) 

Current 
users 

Past 
users 

% 

11 

10 

10 

10 

9 

10 

9 

4 

11 

9 

% 

6 

5 

5 

5 

5 

5 

5 

2 

5 

2 

Used 
once or 
twice 

% 

10 

8 

10 

10 

9 

10 

9 

8 

12 

6 

Never 
used 

% 

73 

76 

76 

75 

77 

75 

77 

86 

72 

83 

Base: respondents in the 26+ age group (N=5,910) 
Question:  Q.4.14.  In  which  settings,  if  any,  do  you  think  that  the  consumption  of  HTPs  should  be 
prohibited? 
Note:  Respondents  could  provide  multiple  answers,  except  if  they  selected  “All  the  above”  or  “None”. 
Hence, a special consideration must be made when analysing the responses. Although 22% reported “open 
outdoor spaces”, 38% of respondents in the age group were in favour of prohibiting product use in open 
outdoor spaces (i.e. 22% + 16% that answered “all of the above”). The group total category refers to the 
total respondents in that age group. The orange column represents the proportion of respondents in the 
age  group  that  selected  the  response  option  (i.e.  1%  of  respondents  in  the  26+  age  group  responded 
“other”). The white cells (in the four right columns) represent the breakdown by user type, i.e. they are 
within row percentages (white cells in each row sum to 100).  
Source: OE elaboration from online survey data 

5.4  Health, social and economic impacts 

As  a  consequence  of  an  increased  awareness  of  combustion-related  health  risks,  HTPs  have  been 
marketed  as  reduced-toxicant  and  less  harmful  alternatives  to  conventional  tobacco  products 
(Pemberton, 2018). Even though the number of toxicants assessed in peer-review articles does not 
cover the full range of harmful and potentially harmful constituents (HPHCs) of interest, both tobacco-
industry and independently funded studies have found a reduction in toxicants and exposure to some 
HPHCs relative to standard cigarettes (e.g. UK COT, 2019, Slade et al, 2002 97; Liu et al., 2019). In 
2017, the UK Committee on Toxicology reported that HTPs are less harmful than traditional cigarettes 

97 Note that this product is an older version of heated tobacco products.  

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Consumer preference and perception of specific categories of tobacco and related products 

and that HTPs reduce the harmful and potentially harmful compounds of conventional cigarettes by 
50 to 90%.98 However, the Committee admitted being unable to fully assess the absolute risk of HTPs 
given the nature of the data available, but suggested that there would likely be a reduction in risk for 
conventional  cigarette  users  deciding  to  use  HTPs  instead  of  smoking  cigarettes,  as  well  as  for 
bystanders (PHE, 2018). 

A systematic review of published peer-reviewed papers showed that the levels of analysed toxicants 
were at least 62% lower than in cigarette smoke and particulate matter (PM) was 75% lower than in 
conventional cigarette smoke (Simonavicius et al., 2019). According to the German Cancer Research 
Centre (DKFZ) (2018b), while acknowledging conflicts of interest and limited study quality, currently 
available studies showed that HTPs contained less HPHCs than conventional tobacco smoke, and that 
the consumer was exposed to less pollutants. They acknowledged that there was nevertheless not an 
inconsiderable risk and that it was still unclear to what extent the lower pollutant load was translated 
into a reduced health risk. The relationship between exposure and health effects is complex and the 
finding  does  not  mean  that  HTPs  are  harmless,  especially  given  that  the  long-term  health  risk 
potentials are currently unknown.  

The mainstream emission from several HTP devices appeared to deliver less nicotine per stick than a 
conventional  cigarette.  Nicotine  delivery  measurements  were  similar  in  the  tobacco  industry  and 
independently funded studies. Studies with humans that measured plasma nicotine levels after use of 
HTPs  indicate  that  nicotine  delivery  of  HTPs  varies  by  brand  but  is  systematically  lower  than  that 
supplied by a conventional cigarette, with some exceptions (WHO, 2019b). Further, the mouth-level 
exposure was found to be lower with some HTPs (e.g. glo from British American Tobacco, BAT) than 
with  conventional  cigarettes,  especially  for  nicotine  (Gee  et  al.,  2018).  However,  the  overall 
information on product composition is still limited. The reports submitted by PMI to the FDA include 
levels of 57 other constituents that are not included in the FDA’s list of HPHCs. The level of 56 of them 
was higher in IQOS  emissions than in conventional cigarettes. The levels were double those in the 
reference  conventional  cigarettes  for  22  compounds  and  more  than  10  times  higher  for  seven.  It 
appears that IQOS reduces exposure to some toxicants but elevates exposure to other substances. A 
number of these substances belong to chemical classes that are known to have significant toxicity, 
but in general, there is limited information on the toxicity of many of them (WHO, 2019b). 

In Europe, toxicological assessments of tobacco products have aimed at excluding elevated risks in 
relation to conventional products, but not to confirm less hazardous product properties (Mallock et al., 
2019). The Spanish Ministry of Health (2019, Spain) stated that the compounds of HTPs are similar 
to  conventional  cigarettes  and  that  these  compounds  can  be  toxic  with  or  without  combustion. 
Laboratory-based findings have suggested lung damage, although these do not translate to reduced 
risks in humans and still very little is known on the exact health effects of HTPs on humans (Psinger 
et  al,  2019).  Experimental  animal  studies  showed  pulmonary  inflammation,  while  in  vitro  studies 
showed no improvement of lung function from switching from combustible to HTPs. Nicotine and tar 
were  also  detected  at  almost  identical  levels  to  those  found  in  a  conventional  cigarette. 99  Several 
studies have also detected potentially toxic substances in HTP emissions. Independent assessment of 
industry data found over 20 harmful and potentially harmful constituents (HPHCs) in emissions that 
were significantly higher than in conventional cigarette smoke (St Helen et al, 2018), some of which 
carcinogen. Another study found that potentially carcinogenic substance had almost 3 times the level 
of those found in conventional cigarettes, and highly toxic compounds could also be released (namely, 

98 https://cot.food.gov.uk/sites/default/files/heat_not_burn_tobacco_summary.pdf  
99 ERS Position Paper on Heated Tobacco Products: A statement prepared by the ERS Tobacco Control Committee and 
approved by the ERS Advocacy Council, Science Council and Executive Committee. Available at: https://www.ersnet.org/the-
society/news/ers-position-paper-on-heated-tobacco-products 

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formaldehyde cyanohydrin) - a great concern due to its high toxicity at very low concentrations (Leigh 
et  al.,  2018).  These  findings  were  also  corroborated  by  the  German  Cancer  Research  Centre,  who 
concluded that toxic compounds are not completely removed from the HTP aerosol and these products 
were not risk-free (DKFZ, 2018b).  

In  terms  of  health  impacts  WHO  2020  reported  that  currently  there  is  insufficient  evidence  to 
determine the harm associated with HTPs in relation to conventional tobacco products. In November 
2019,  the  Standing  Committee  of  European  Doctors  (CPME)  raised  concerns  on  the  health  risks  of 
these emerging tobacco products, highlighting that they fell in a dangerous regulatory gap. Based on 
submissions to some regulatory agencies, the industry has not been able to demonstrate that these 
products  will  reduce  tobacco-related  disease  (WHO,  2020).  For  example,  PMI  reported  in  its 
submission to the United States Food and Drug Administration (FDA) on 40 of the 93 HPHCs in IQOS 
mainstream emission recommended by the agency.100 The levels of the missing 53 HPHCs, of which 
50 are carcinogenic, are unknown (WHO, 2019b). Additional independent studies will be required to 
substantiate any claims of reduced risk/harm relative to conventional cigarettes. More evidence is also 
needed on the effects of HTPs to passive users (WHO, 2020; McKelvey et al., 2018). The WHO (2018) 
has emphasised that all forms of tobacco use are harmful, including HTPs, and have recommended 
that HTPs be subject to the same policy and regulatory measures applied to all other tobacco products, 
in line with the WHO Framework Convention on Tobacco Control (WHO FCTC). 

As  per  Article  13,  Member  States  should  ban  misleading  elements,  notably  any  suggestions  that  a 
particular tobacco product is less harmful than others. As further research throws light on the precise 
health  impacts  of  HTPs,  the  market  developments  should  be  closely  monitored  to  avoid  the 
renormalisation  of  tobacco  consumption.  For  example,  there  has  been  concern  in  the  UK  over  the 
potential for non-smokers, and especially younger generations, to take up using HTPs because they 
may believe the product is less harmful. In addition, there is still no evidence that HTPs are efficient 
as smoking cessation aid.101 Furthermore, as reported in the Study on Council Directive 2011/64/EU 
on the structure and rates of excise duty applied to manufactured tobacco, the HTPs national fiscal 
policies are fragmented across Europe: 

“For  instance,  Italy  has  adopted  a  product-specific  approach  by  establishing  an 
equivalence  of  time  consumption  to  conventional  cigarettes  under  the  same  puffing 
conditions and applying a 50% reduction (that will significantly reduce in the course of 
2019); in Portugal there is a mixed approach with an ad valorem component, a specific 
component and a minimum excise; Hungary has a fully specific non harmonised tax per 
items (and not per weight); six MS (including DE, FR and UK) consider it a harmonised 
product and apply the tax regime of other smoking tobacco (per weight in Kg), with the 
UK  including  the  entire  stick  (with  filter  etc.)  in  the  tax  base;  Slovenia  applies  the 
harmonised regime of FCT (per weight in Kg)” 102  

The novelty of the policies and the product make it difficult to interpret how they affect consumption 
of the product. However, in terms of economic factors, HTPs (and IQOS in particular) were regarded 

100 In compliance with the Tobacco Control Act, versions of the application are available for public review and comment on the 
website  of  the  FDA  (https://www.fda.gov/tobaccoproducts/labeling/marketingandadvertising/ucm546281.htm),  but  much  of 
the technical information has been redacted for confidentiality. 
101 Statement on the toxicological evaluation of novel heat-not-burn tobacco products, Committees on Toxicity, Carcinogenicity 
and  Mutagenicity  of  Chemicals  in  Food,  Consumer  Products  and  the  Environment  (COT,  COC  and  COM),  available  at: 
https://cot.food.gov.uk/cotstatements/cotstatementsyrs/cot-statements-2017/statement-on-heat-not-burn-tobacco-
products, 11 December 2017. 
102  In  the  European  Commission  (2020):  Study  on  Council  Directive  2011/64/EU  on  the  structure  and  rates  of  excise  duty 
applied to manufactured tobacco, HTPs are grouped under ‘Other smoking tobacco` 

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as very expensive by participants in the present study, except in Germany, with respect to both the 
heating device and the tobacco sticks.  

Table 50. Overview of non-harmonised taxes for heated tobacco products 

Country 

Heated Tobacco Products 

PT 

IT 

RO 

SI 

LV 

HU 

EL 

HR 

SK 

Ad valorem 16% of RSP and specific € 80/kg. Minimum Excise: €169/kg 

Depending on SKU: € 63.25 to € 63.36/ 1,000 sticks 

RON 384/Kg (ca. € 86.5/93.2) 

€88/kg  

€62/kg  

HUF 10,000 / per 1,000 sticks (€32.46) 

€ 156.7 / kg  

HRK 600 / kg (ca. €80.7) ( 

€73.9/kg  

Source: European Commission (2020) 

5.5  Concluding remarks on novel tobacco products 

The main findings on novel tobacco products are summarised below. Heated tobacco products (HTPs) 
were selected as the most recent and most widely known novel tobacco products (NTPs) in the EU. 
The  novelty  of  HTPs  inevitably  carries  the  consequence  of  a  limited  research  base.  The  systematic 
review of secondary sources revealed: 

  Since younger generations are increasingly less likely to smoke conventional tobacco products, 
tobacco companies have developed new products which are marketed as “safer” alternatives. 
There has been a proliferation of novel tobacco products entering the EU market. Of particular 
significance to the TPD are heated tobacco products (HTPs). They have been marketed in over 
40  countries  worldwide  as  of  July  2019,  with at  least  22  countries  from  the  WHO  European 
region. 

  Heated  tobacco  products  (HTPs)  are  tobacco  products  that  produce  an  emission  containing 
nicotine and other chemicals, which is then inhaled by users. They have been marketed as so-
called potentially reduced risk exposure products, or even as modified-risk tobacco products. 
Currently,  there  is  insufficient  evidence  to  conclude  that  HTPs  are  less  harmful  than 
conventional cigarettes. There are concerns that while they may expose users to lower levels 
of some toxicants than conventional cigarettes, they also expose users to higher levels of other 
toxicants. It is still unclear how this toxicological profile translates into short- and long-term 
health effects.  

  Market size and prospect. According to Passport data (2017), HTP sales were 769 million euros. 
The leading markets were Italy and Romania. Although there is no time series trend data on 
HTP sales or HTP use, the market size for HTP is expected to grow soon but there is still a big 
gap before it reaches the size of the market for conventional tobacco cigarettes (EC, 2017). 

  Marketing  HTPs.  Marketing  and  promotion  has  included  alleviating  health  concerns  through 
claims that HTPs are reduced-risk products; designing HTP systems to boost the user’s social 
image;  using  “bait  and  hook”  pricing  strategy;  employing  social  marketing  techniques  and 

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brand ambassadors; selling and marketing via multiple channels, including dedicated stores, 
retail establishments and e-commerce websites. 

  According to the  few  existing population surveys, the prevalence  of HTP current use among 

adults is less than 0.5% in the general population of European Union MS.  

  Member States have adopted different definitions of HTPs with respect to taxes, resulting in 
substantial fragmentation of the EU internal market and resulting in a large variation in prices 
across European countries in which the product is available.  

The  empirical  research  (focus  groups  and  online  survey)  revealed  that  HTPs  were  the  least  known 
product among the products under study. HTPs and electronic cigarettes were sometimes confused, 
considered  to  be  similar  products,  and  believed  to  not  be  as  satisfying  as  conventional  tobacco 
products. The study revealed the following user profile: 

  Everyday use of HTPs with 1 to 10 sticks was typical for current users. Initiation of use was 
motivated  by  either  enjoyment  or  trying  to  quit  or  reduce  smoking  of  conventional  tobacco 
products. About 85% were dual users.  

  Current  HTP  users  were  evenly  split  between  those  than  had  never  attempted  quitting  and 
those who tried at least once and failed in the 18-25 group. In the 26+ group, almost two out 
of three had never tried to quit. Among failed quitters, the main reasons to try quitting were 
for  ‘personal  health’  and  ‘economic  reasons’.  In  the  26+  group,  another  reason  frequently 
mentioned was the ‘concern for the health of the people around them’. The main reason cited 
for failing to quit was being ‘stressed’. In the 26+ group, another important reason was that 
they found quitting HTPs ‘too difficult’. 

  The majority of past users of HTPs were still using other tobacco products at the time of the 

survey.   

Lastly, the following paragraphs highlight the Product and Regulatory perceptions remarks 

  Source of awareness of HTP. A formal source of advertising and promotion of the product (38% 
in the 18-25 group, 45% in the 26+ group) was the most common introduction to HTPs. Word-
of-mouth was a close second source. 

  Perception  of  harm.  Conventional  cigarettes  were  perceived  to  be  the  most  harmful  to  the 
health  of  users  and  bystanders.  Comparing  the  risk  perception  of  users  of  conventional 
cigarettes with the users of HTPs, the 18-25 age group rated HTPs as 35% less harmful than 
conventional cigarettes to users and 46% less harmful  to bystanders. In the 26+ age group 
HTPs were perceived to be 52% less harmful to users and 58% less harmful to bystanders. 

  Regulatory  perceptions.  About  75%  of  respondents  agree  that  HTPs  should  be  regulated  as 
conventional cigarettes and a many support restrictions in use in workplaces, public transport 
and the hospitality sector.  

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6  Electronic cigarettes  

6.1  Background 

According  to  the  World  Health  Organisation  (WHO),  there  was  a  50%  increase  in  the  use  of  e-
cigarettes among both adults and adolescents between 2008 and 2012, with evidence that this trend 
would continue (Schneider & Diehl, 2016). In 2012, approximately 29.3 million European Union adults 
had tried e-cigarettes (Vardavas, 2015, EU, N=26,566). Various types of e-cigarette devices are used 
and have  co-existed  on the market.  However,  open tanks103 and modular systems104 have grown in 
popularity in Europe over the past years and account for the majority of the market (between 60% 
and  90%,  depending  on  the  source),  whereas  disposable  devices105  and  cig-a-likes106  have  declined 
(EC, 2016; EC, 2017). 

Market development. The structure of the EU market of electronic cigarettes in 2017 is depicted in 
the figure below. It was mainly concentrated in Western Europe, with the largest market in the UK 
(1,538 m EUR), followed by Italy (597 m EUR), Germany (524 m EUR) and France (402 m EUR). 

Figure 127. Market size of electronic cigarettes in million euros in 2017 

Note:  The  market  size  is  estimated  total  sales  in  million  euros  for  2017,  without  population 
adjustments.  It  is  displayed as  a  tree  map  graph  that  consists  of series  of  nested  rectangles  of 
sizes proportional to the corresponding data value. 
Source: OE elaboration of Passport, 2017 

103 Tank systems are second-generation e-cigarettes. They are typically shaped like pens and feature a transparent reservoir to 
hold the liquid. There are “open” and “closed”-tank systems.  
104 Modular systems are the latest generation on the market, aesthetically departing from the cigarette-like shape. They allow 
various degrees of customization of component parts and allow users to regulate the power delivery and other settings. 
105 Refers to the “closed tank” systems.  
106  Cig-a-likes  are  the  first-generation  of  electronic  cigarettes  and,  as  suggested  by  their  name,  often  resemble  cigarettes 
(although not necessarily). They can be disposable or rechargeable using prefilled cartridges. 

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The UK was not only the largest market of e-cigarettes in absolute values, but it also had the highest 
share of e-cigarettes of the total national market (in m. EUR) compared to the other EU countries – 
reaching almost 7% (see Figure 128). The e-cigarette market in Europe saw a continuous expansion 
since 2008.107 According to the Eurobarometer 458 (2017), 15% of respondents had at least tried e-
cigarettes, an increase for 3% since 2014. The proportion of current users has remained stable at 2%. 
The growth in past years has been partly attributable to the strong marketing practices of the industry. 
The  Eurobarometer  found  that  44%  of  respondents  had  seen  advertisements  for  e-cigarettes,  with 
7%  reported  seeing them  ‘often’.  The UK actively promoted the use  of e-cigarettes as an  effective 
tobacco  cessation  aid  (PHE,  2018108).).  The  Eurobarometer  found  that  British  respondents  were 
exposed to more advertisement for e-cigarettes than the average EU citizen (65% in the UK with an 
EU average of 44%) (Eurobarometer, 2017). 

Figure 128. Share of electronic cigarettes within the national total tobacco market, per country (2017) 

Note: Percentage share of electronic cigarettes were estimated with respect to the whole tobacco market 
in the country in million euros. 
Source: OE elaboration of Passport, 2017 

107 https://ec.europa.eu/health/sites/health/files/tobacco/docs/potentialrisks_specs_refillableecigarettes.pdf 
108 https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review 

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Consumer preference and perception of specific categories of tobacco and related products 

Where data is available, Figure 129 shows the trend of increased current retail selling price (RSP) of 
e-cigarettes. The crude EU average of price increases was of four-fold between 2012 and 2017. The 
most significant increases occurred in Portugal, Sweden and Latvia. 

Figure 129 Price dynamics of electronic cigarettes (in retail selling prices, RSP): 2012-2017 

Note:  The  EU  average  (in  red)  was  calculated  for  24  EU  MS  (excluding  Cyprus,  Luxembourg,  Malta  & 
Slovenia – as there was no available data for the countries). It is the sum of all current Retail Sale Price 
(RSP) (in euro) in all countries over the number of countries for which the data was available for 2012 and 
for  2017  separately.  These  values  were  then  used  in  the  current  price  growth  formula  to  establish  the 
growth between these two years. 
Source: OE elaboration of Passport, 2017 

Several  determinants  of  e-cigarette  use,  including  age,  gender  and  place  of  residence  have  been 
explored. Tarrazo (2017, Spain, N=16,000) found that age was a significant determinant of e-cigarette 
use, with young people (aged 15-24) more likely to use e-cigarettes than young adults (aged 25-39) 
or  adults  (aged  40-54).  Kristjansson  (2017,  EU)  found  that  15  to  17-year-olds  reported  having 
experimented with e-cigarettes at least once in their lifetime and 20% had used them three times or 
more. On gender and marital status, Vardavas (2015, EU, N=26,566) found no significant differences 
in ‘ever users’ of e-cigarettes. Several studies found that underage males were more likely to use or 
to try them compared to females of similar age (Lindström, 2018, Sweden, N=17,092; Kotz et al., 
2018, Germany, N=12,273; Kinnunen, 2015, Finland, N=3,535; Coleman, 2015, USA, N=4,310). E-
cigarette adult users were also more likely to live in urban rather than rural areas (Vardavas, 2015; 
Tarrazo, 2016). Furthermore, e-cigarette users were more likely to be living in Northern or Eastern 
Europe as opposed to Western Europe (Vardavas, 2015). In terms of the type of e-cigarette, Kotz et 
al. (2018, Germany) found that 66% of German e-cigarette users had a tank refilled by the user, i.e. 
an open system (third generation of e-cigarettes). 

Vardavas (2015) reported a positive correlation between e-cigarette use and previous conventional 
tobacco smoking among European youth and adults. Furthermore on dual use has been reported in 
other studies (ASH, 2018; Strong, 2019, USA, N=14,287). However, Action on Smoking and Health 
(ASH)109 reported that current e-cigarette users were more likely to be former consumers of tobacco 
products (1.7 million) rather than dual users with other tobacco products (1.4 million) in the UK. The 
results  suggested  that  the  main  reason  for  e-cigarette  use  in  the  UK  was  to  quit  other  tobacco 

109  A  public  health  charity  in  the  UK.  https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-
2019.pdf  

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Consumer preference and perception of specific categories of tobacco and related products 

products. Pokhrel (2015, USA) provided a framework comprising three broad contexts of e-cigarette 
use among dual users.  

  Activities.  This  refers  to  the  types  of  activity  associated  with  e-cigarette  use  instead  of 
conventional cigarettes. Two activities fall under this category (i) before or during work-out or 
physical activity and (ii) when working  - users tend to prefer using e-cigarettes  when doing 
physical activity as they perceive that it does not affect their performance.  

  Places/situations. Certain places or situations were perceived to be more conductive to e-
cigarette use.  It was viewed as more suitable for indoor use (e.g. no  smell, reduced risk of 
passive smoking). Participants perceived  e-cigarette use to be a  more personal (they would 
not share their e-cigarette with other people) and a solitary activity – as compared to waterpipe 
tobacco use. 

  Tobacco substitution. Three situations were reported to be drivers of e-cigarette use as a 
tobacco substitute, namely; (i) when cigarettes were not available; (ii) when a hookah was not 
available;  and  (iii)  when  smoking  was  not  allowed.  E-cigarette  use  as  a  substitute  for 
conventional cigarette smoking was associated with the temporary reduction of cravings. 

Schneider & Diehl (2016, USA) proposed a model to explain the dynamics of e-cigarette use patterns, 
and notably the association between  e-cigarette use and the likelihood of  subsequent conventional 
tobacco consumption. The model identified causalities involved in the transition from no consumption 
to tobacco consumption in two trajectories: from abstinence to e-cigarette use, and from there to the 
consumption of tobacco cigarettes. To do so, drawing on the literature they extracted the following 
hypotheses (see Table 51). 

Table 51. Hypotheses proposed in the Schneider & Diehl (2016) model 

Category 

Name 

Description 

Explanations for 
the initiation of e-
cigarette use 

The flavour 
hypothesis 

The health 
hypothesis 

The role model 
hypothesis 

The multitude of e-cigarette flavours available, such as candy, 
chocolate or strawberry, make the initial use of e-cigarettes more 
likely than starting to smoke tobacco, especially among 
adolescents 

The assumption that e-cigarettes pose fewer health risks than 
tobacco cigarettes makes the initial use of e-cigarettes more likely 
than starting to smoke tobacco, especially among adolescents. 

The assumption that e-cigarette users are more likely to be seen 
as role models by their peers makes the initial use of e-cigarettes 
more likely than starting to smoke tobacco, especially among 
adolescents. 

The concealment 
hypothesis 

The fact that e-cigarettes are easier to conceal makes the initial 
use of e-cigarettes more likely than starting to smoke tobacco, 
especially among adolescents. 

The acceptance 
hypothesis 

The perception that e-cigarettes are more socially accepted makes 
the initial use of e-cigarettes more likely than starting to smoke 
tobacco, especially among adolescents. 

The addiction 
hypothesis 

The fact that nicotine is addictive makes e-cigarette users more 
likely than non-users to start smoking tobacco, especially among 
adolescents. 

The accessibility 
hypothesis 

The fact that e-cigarettes and tobacco cigarettes are often 
available through the same commercial and social sources makes 
users more likely than nonusers to start smoking tobacco, 
especially among adolescents. 

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Category 

Name 

Description 

Explanations for 
any transition to 
tobacco cigarette 

consumption 

Explanations 
outside the model 

The experience 
hypothesis 

Experience with the use of e-cigarettes makes users more likely 
than non-users to start smoking tobacco, especially among 
adolescents. 

The liability 
hypothesis 

Individual predisposition and specific socialization make the 
initiation of e-cigarette and tobacco use more likely, especially 
among adolescents. 

The 
renormalization 
hypothesis 

The increasing rate of e-cigarette use leads to the renormalization 
of smoking and to more people initiating tobacco smoking, 
especially among adolescents. 

Source: Own elaboration from Schneider & Diehl (2016) 

The model proposed by Schneider & Diehl has been supported by several studies (Leventhal et al., 
2015, USA, N=2,530; East et al., 2018, UK, N=932; Kinnunen et al., 2015). Findings have established 
a correlation between e-cigarette ever use and the likelihood  of initiating  conventional tobacco use 
during early adolescence – especially for nicotine e-cigarettes – as under aged users may develop an 
addiction which they eventually satisfy through conventional cigarettes.  

Several  studies  have  explored  the  outreach  of  the  industry  to  attract  consumers.  The  multi-billion 
Euro industry has used a variety of channels to target current tobacco users, former tobacco users, 
and young non-tobacco users. Notably, the availability and online marketing of e-cigarettes has been 
considered a driver for the market development. In a study on Finnish teenagers, Kinnunen (2015, 
Finland,  N=3,535)  reported  that  the  internet  was  the  second  most  common  source  for  e-cigarette 
acquisition. A study by Martinez (2015, Spain, N=736) found that most of participants discovered e-
cigarettes through media marketing strategies promoting them as a safer option than conventional 
cigarettes.  The  TPD  has  regulated  marketing  of  e-cigarettes  since  its  transposition  in  2016  across 
Member States.110 However, the globalised internet is a challenge national legislation. While different 
advertising  regulations  apply,  studies  in  the  USA  identified  the  use  of  online  tools  and  mobile 
applications to target youth (O’Brien, 2018; Krugman, 2016). Krugman (2016) argued that marketing 
communications  on  e-cigarettes  were  ‘normalising’  the  product  category  and  cultivating  favourable 
perceptions  among  young  people.  Through  the  internet,  European  youth  also  has  access  to  these 
advertisements,  despite  efforts  to  limit  exposure  to  them.  A  2016  EC-commissioned  study111  found 
examples of content originating from producers or retailers which appeared to promote tobacco, such 
as  prize  draws,  news  items  about  tobacco  retailing,  and  ‘corporate’  content.  The  study  also  found 
examples of user-generated content appearing to promote specific tobacco brands and products on 
Facebook which, in effect, could be considered as tobacco advertising. 

El-Toukhy et al. (2018, USA, N=5,766) analysed the impact of marketing practices that claimed lower 
risks to health harms for alternative tobacco products (i.e. e-cigarettes and heated tobacco products) 
on the perceived risks. The study concluded that:  

  The  public  inferred  that  both  risk  and  exposure  to  harmful  chemicals  was  lower  when  they 

‘learned’ that either one was lower; 

  Participants perceived lower risk from alternative tobacco products due to lower quantities of 

harmful chemicals and less harm to health; 

  Reduced quantities of chemicals were associated with lower perceived harm; 
  Perceived risk and perceived chemical quantity were highly correlated; 

110 https://ec.europa.eu/health/sites/health/files/tobacco/docs/citizensexposure_tobaccomarketing_en.pdf  
111 https://ec.europa.eu/health/sites/health/files/tobacco/docs/citizensexposure_tobaccomarketing_en.pdf  

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Consumer preference and perception of specific categories of tobacco and related products 

  Perceived risk was insensitive to pictorial warnings and other persuasive approaches; 
  Lower exposure claims influenced the assessment of alternative tobacco products harm; 

The  marketing  activities  of  e-cigarette  companies  have  increased  dramatically  over  recent  years, 
notably in social media. 112 While most of the marketing or pseudo-marketing content originates from 
the  USA,  globalisation  threatens  efforts  to  minimise  the  exposure  of  younger  generations  to 
advertisements and marketing. In the 2014 Eurobarometer,113 young respondents were more exposed 
than any other age category to advertisements or promotions for e-cigarettes: 12% of them reported 
having seen them often vs. 5% of those aged 55+.  

Consumer perception. Laverty et al. (2016, EU, N=2,430) found that ‘ever users’ of tobacco and e-
cigarettes  were  likely  to  be  influenced  by  taste,  price  and  nicotine  content  of  e-cigarettes.  In 
comparison to older people, those aged 15-24 years were more likely to cite packaging and design 
features as important, as well as being influenced by the price of e-cigarettes. Kotz, Böckmann and 
Kastaun (2018, Germany) suggested that the major reasons stated for the use of e-cigarettes among 
young users  were the array  of flavours,  followed by the potential to help in reducing their tobacco 
consumption. In a recent systematic review Meernik et al. (2019, global) found consistent evidence 
that flavours (some 7000) were attractive to both youth and adults.  

Table 52 presents findings from the Eurobarometer 458 survey (2017) on the factors that influence 
consumers’  choice  of  e-cigarettes.  The  survey  found  that  consumers’  decision  to  start  using  e-
cigarettes was mainly driven by health rather than social or aesthetics  reasons. A large majority of 
respondents (61%) cited ‘‘‘to stop or reduce their tobacco consumption’. as a reason for initiating e-
cigarette use. The second most stated reason (31%) was the belief that the product was less harmful 
than other tobacco products. A lower price, relative to other tobacco products was cited by 25% of 
respondents.  Other  studies  have  found  a  significant  positive  correlation  between  attempts  to  quit 
traditional  tobacco  consumption  and  e-cigarette  use  (Chapman,  2014,  USA;  Giovenco,  2018,  USA, 
N=15,532).  

112 https://ec.europa.eu/health/sites/health/files/tobacco/docs/potentialrisks_specs_refillableecigarettes.pdf  
113 Special Eurobarometer 429. Attitudes of Europeans towards Tobacco and Electronic Cigarettes. 
http://ec.europa.eu/public_opinion/archives/ebs/ebs_429_en.pdf  

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Table 52. Reasons for initiating use e-cigarettes  

(% - of current and past users)  

To stop or 
reduce your 
tobacco 
consumption, 
% 

They 
were cool 
or 
attractive, 
% 

So you 
could 
vape in 
places 
where 
tobacco 
smoking 
is not 
allowed, 
% 

They were 
cheaper 
than 
tobacco,% 

Your 
friends 
used e-
cigarettes, 
% 

You liked 
the 
flavours 
of e-
cigarettes, 
% 

Other 

N/A, 

%  

You 
believed 
that 
vaping 
was 
less 
harmful 
than 
using 
tobacco, 
% 

EU28 

61 

AT 

BE 

BG 

CY 

CZ 

DE 

DK 

EE 

EL 

ES 

FI 

FR 

HR 

HU 

IE 

IT 

LT 

LU 

LV 

MT 

NL 

PL 

PT 

RO 

SE 

SI 

SK 

UK 

50 

55 

39 

63 

48 

50 

74 

51 

69 

88 

59 

79 

61 

34 

65 

33 

37 

61 

47 

60 

72 

29 

65 

24 

80 

19 

18 

64 

6 

13 

12 

7 

8 

7 

8 

- 

1 

5 

8 

4 

-  

10 

7 

2 

25 

5 

-  

7 

12 

-  

11 

11 

11 

2 

13 

12 

2 

15 

31 

14 

37 

24 

27 

25 

19 

8 

19 

10 

8 

17 

27 

18 

5 

10 

7 

6 

22 

14 

26 

7 

26 

22 

26 

28 

14 

5 

25 

26 

25 

7 

18 

19 

32 

25 

11 

11 

19 

18 

31 

32 

20 

33 

26 

32 

12 

18 

12 

21 

18 

15 

11 

16 

17 

38 

18 

11 

23 

20 

8 

14 

23 

5 

12 

22 

17 

7 

14 

5 

9 

13 

11 

24 

32 

17 

26 

15 

17 

28 

3 

13 

6 

26 

25 

6 

12  

25  

21  

11  

11  

14 

28 

13 

20 

-  

6 

9 

4 

5 

15 

-  

6 

21 

2 

24 

3 

9 

22 

12 

7 

32 

8 

-  

15 

31  

38  

22  

23  

40  

28 

36 

34 

32 

39 

20 

31 

34 

42 

38 

33 

25 

12 

34 

16 

33 

30 

18 

37 

10 

33 

39 

44 

32 

5  

3  

7  

4  

0  

3 

8 

6 

13 

0 

3 

3 

2 

5 

3 

0 

2 

6 

6 

12 

8 

8 

9 

8 

28 

6 

4 

0 

6 

Base: respondents who currently use or used e-cigarettes, N=1,565 
Question: QB14 of Eurobarometer 458 – “Which of the following factors, if any, were important in your 
decision to start using e-cigarettes?” 
Note: Respondents were able to select up to 3 reasons. The share of respondents that selected each reason 
is provided in the table, per country.  
Source: Eurobarometer 458, 2017 

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While e-cigarettes have been promoted as an aid to cessation, a majority (55%) of EU respondents 
perceived them as harmful to health (see Table 53). The table below shows striking variation in the 
perception of harmfulness, from 85% in the Netherlands to 34% in Italy 

Table 53. Perception of harmfulness e-cigarettes 

Yes 
% 

55 

EU28 

AT 

BE 

BG 

CY 

CZ 

DE 

DK 

EE 

EL 

ES 

FI 

FR 

HR 

HU 

IE 

IT 

LT 

LU 

LV 

MT 

NL 

PL 

PT 

RO 

SE 

SI 

SK 

UK 

47 

62 

45 

76 

56 

54 

79 

75 

65 

60 

81 

62 

51 

49 

59 

34 

80 

76 

80 

67 

85 

56 

58 

48 

65 

65 

48 

50 

No 
% 

28 

40 

34 

16 

11 

30 

32 

13 

11 

19 

19 

11 

21 

32 

39 

27 

46 

11 

12 

11 

20 

7 

28 

26 

37 

14 

22 

36 

29 

I don’t know  
% 

17 

13 

4 

39 

13 

14 

14 

8 

14 

16 

21 

8 

17 

17 

12 

14 

20 

9 

12 

9 

13 

8 

16 

16 

15 

21 

13 

16 

21 

Base: all respondents, N=27,901 
Question: question QB9 of the Eurobarometer – “In recent years electronic cigarettes or e-cigarettes have 
been increasingly marketed in Europe. Do you think that they are harmful or not to the health of those 
who use them?” 
Source: Eurobarometer 458, 2017 

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Consumer preference and perception of specific categories of tobacco and related products 

Meernik et al. (2019) found that the perception of harm of e-cigarettes was dependent on the product 
flavouring,  notably  amongst  the  youth.  114  Specifically,  fruit  and  candy-flavoured  e-cigarettes  were 
perceived as less harmful than tobacco-flavoured e-cigarettes. In similar vein Czoli (2016) (Canada, 
N=915)  found  that  e-cigarette  flavour  significantly  predicted  lower  perceptions  of  product  harm. 
Several studies have found that both young (aged 12-17) and adult (aged <65) populations perceived 
e-cigarettes115  as  less  harmful  than  conventional  cigarettes  in  Europe  and  the  Western  region 
(Martinez, 2015, Spain, N=736; Strong, 2019, USA, N=13,620). Other studies116 conducted outside 
of the EU have found that the awareness of e-cigarette has increased over the years (McNeill et al., 
2018, UK; Huerta, 2017, USA, N=10,492117; Huang et al., 2019, USA, N=24,442118), and that while it 
may be relatively less harmful than conventional tobacco consumption, it still carried potential risks 
for users.  

Impacts. Results from the literature review suggested that health risks associated with e-cigarettes 
were still uncertain and inconclusive (PHE, 2018; RCP, 2016; Hua, 2016; Meo, 2014; Callahan-Lyon, 
2014;  Kim,  2016)  as  previously  suggested  in  section  6.1.  However,  the  long-term  harms  of  these 
products remained unknown (Czoli, 2017; Andler, 2015, France; NASEM, 2018). The evidence showed 
that the level of exposure to nicotine from e-cigarettes is variable, depending on the characteristics 
of the device and the e-liquid, as well as on how the device is operated. Callahan-Lyon (2014) reported 
that  differences  in  product  engineering,  components  and  potential  toxicities  hinder  the  study  of  e-
cigarettes as a single device.  

In  the  USA,  a  lung  ailment  reportedly  killed  and  afflicted  several  patients  in  the  last  few  years.119 
While this disease highlighted the need for further investigations on the product and its composition, 
differences in the regulatory arrangement of the US and the EU, protected EU citizens from the risk 
as further explained in section 6.2.3.120  

Pisinger (2014) outlined some methodological challenges that must be acknowledged in the research 
on e-cigarette health impacts. First, with research covering some hundreds of brands that had been 
subject  to  frequent  modifications,  it  is  a  challenge  to  arrive  at  valid  generalisations.  Furthermore, 
many studies have compared the health impacts of e-cigarettes with conventional cigarettes and also 
with non-users, whereas health hazards for each product may be different. For example, e-cigarette 
use  topography  is  quite  different  to  conventional  smoking  as  use  of  e-cigarettes  involves  sucking 
harder with longer puffs. Finally, some experimental studies with human participants may not reflect 
real-life use of e-cigarettes.  

Many recent studies have argued for the need to better codify and understand the health impacts of 
e-cigarettes in order to have evidence-based policies for tobacco control (PHE, 2018; RCP, 2016; Hua, 
2016;  Kim,  2016).  Levy  (2017)  proposed  a  framework  describing  and  incorporating  patterns  of 
vaporised nicotine products (VNPs), such as e-cigarettes and HTPs, to determine the total amount of 
toxic exposure effects on a population health. While the framework identified some critical information, 
it is expected that there will be further product innovations and changes in patterns of use such that 

114 The finding from Meernik et al. (2019) stems from studies conducted in 2016.  
115 As well as waterpipe tobacco, which was also under the scope of some of the cited studies.  
116 External referring to outside of the EU.  
117 N=3,630 in 2012; N=3,185 in 2013; N=3,677 in 2014 
118 N=2,800 in 2012; N=5,668 in 2014; N=5,372 in 2015; N=5,245 in 2016; N=5,357 in 2017 
119 "Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping". Centers for Disease Control and Prevention. 28 January 
2020.  This  article 
the  public  domain.  Available  at: 
this  source,  which 
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html  
120 There have been suspected cases (e.g. Belgium) but the underlying cause has not yet been clarified.  
https://www.europarl.europa.eu/doceo/document/P-9-2019-003949-ASW_EN.html 

incorporates 

from 

text 

in 

is 

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Consumer preference and perception of specific categories of tobacco and related products 

health risks may change as well. Kalkhoran (2015, UK & USA) developed a model to evaluate potential 
health  effects  of  varying  scenarios  of  increasing  promotion  and  use  of  e-cigarettes.  The  outcome, 
supported by results from Polosa (2013)121 was that greater e-cigarette use could have different health 
effects for different population segments.  

Controversy surrounds the public health response to the health impacts of e-cigarettes as exemplified 
by  the  contrasting  conclusions  and  policy  recommendations  in  reports  from  Public  Health  England 
(PHE) and the Food and Drugs Administration (FDA) who had commissioned a report on e-cigarettes 
from the National Academies of Science, Engineering and Medicine in the United States (NASEM). The 
issue  was,  and  still  is,  whether  e-cigarettes  were  an  aid  to  quitting  conventional  cigarettes  or  at 
minimum a means to reduce health risks (the cessation scenario) or whether young people would take 
up the use of e-cigarettes and progress to conventional cigarettes (the gateway scenario).  

Fairchild et al, (2019) point to the crux of the controversy “whose risk should be given priority”. For 
the US Authorities the protection of children is the paramount goal, while for PHE the goal is to protect 
current smokers of traditional tobacco products. 

PHE reported that “the current best estimate is that e-cigarettes are around 95% less harmful” than 
traditional cigarettes. PHE reported concern that “Nearly half the population don’t realise e-cigarettes 
are  much  less  harmful  than  smoking”.  Their  conclusion  was  that  if  current  smokers  of  traditional 
cigarettes  switched  to  e-cigarettes  the  number  of  smoking  related  illnesses  and  deaths  would  be 
significantly reduced.  

On the evidence regarding the gateway scenario, e-cigarettes acting as a route for young people to 
use conventional cigarettes, PHE states that “despite some experimentation with these devices among 
never smokers, e-cigarettes are attracting very few young people who have never smoked into regular 
use. 

The  NASEM  reported that e-cigarettes are  “not safe but safer” and acknowledged that e-cigarettes 
“might  be  useful  as  a  cessation  aid  to  smokers  who  use  e-cigarettes  exclusively”.  The  report 
highlighted the risks to young people and to bystanders. On the gateway scenario “youth who begin 
with  e-cigarettes  are  more  likely  to  transition  to  combustible  tobacco  cigarette  use  and  become 
smokers who may be at risk to suffer the known health burdens of combustible tobacco cigarettes”.  

Fairchild et al, (2019) noted the fear of “addicting a generation of youth” in the USA and cited statistics 
from the National Youth Risk Behavior Survey that showed “ that vaping in the past 30 days increased 
from 0.6% to 4.9% among middle-school students and 1.5% to 20.8% among high-school students 
between 2011 and 2018. During that period, regulators were most alarmed by a spike between 2017 
and 2018: past-30-day e-cigarette use increased 48% among middle schoolers and 78% among high 
schoolers”. 

PHE cited Action on Smoking and Health data that show similar trends: between 2014 and 2018, the 
percentage of youths reporting that they had ever tried an e-cigarette increased from 6.5% to 11.7%; 
during that same period, the percentage of youths who were current vapers increased from 1.6% to 
3.4%. 

On the use of e-cigarettes as an aid to quitting conventional cigarettes Hajek et al, 2019, reported a 
randomised control trial that supports PHE’s recommendation of a combined strategy of access to e-
cigarettes supported by behavioural measures. The randomised control trial showed that compared to 
nicotine replacement therapy, e-cigarettes were more effective for smoking cessation for those who 
attended a stop smoking programme. After 12 months, 18.0% of the e-cigarette group and 9.9% of 

121 Disclaimer: the publication was supported by the electronic cigarettes industry. 

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Consumer preference and perception of specific categories of tobacco and related products 

the nicotine replacement group had quit all tobacco products. But, for those who were unsuccessful, 
dual use was evident. 

The NASEM report identifies unique risks associated with e-cigarettes including emissions of aerosol 
metals, other potentially toxic substances and device explosions and draws the conclusion that “more 
and better research on short- and long-term health effects of e-cigarettes, as well as their effects on 
initiation and cessation of combustible tobacco product use, will bring clarity to the question of whether 
e-cigarettes will prove to reduce harm or induce harm at the individual and the population levels”. 

6.2  Market developments  

6.2.1 Socio-demographic characteristics  

The online survey found that the majority (55%) of the 18-25 age group had tried e-cigarettes and 
that 15% were  current  users (see  Figure 130). The highest proportion of  current e-cigarette  users 
was found in the United Kingdom (29%), followed by Poland (24%), France (20%) and Italy (17%). 
The largest share of never users was found in Germany, at 61%.  

Figure 130. Use of e-cigarettes: country breakdown (18-25 age group)  

Percentage of all respondents in the 18-25 age group 

Base: all respondents in the 18-25 age group (N=6,090) 
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: The group total category refers to all respondents within the age group. 
Source: OE elaboration from online survey data 

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Figure 131 reports the pattern of use for the  26+ age group. 45% had tried e-cigarettes and the 
majority (56%) had never used them. 18% were current and 11% past users. Italy was identified as 
the largest consumer of electronic cigarettes with 33% of current users, followed by Spain (26%), the 
United Kingdom (24%) and France (22%). In contrast, Bulgaria, Slovakia and Latvia had relatively 
small shares of current users, but higher percentages of respondents having used the product once 
or twice.  

Figure 131. Use of e-cigarettes: country breakdown (26+ age group) 

 Percentage of all respondents in the 26+ age group 

Base: all respondents in the 26+ age group (N=5,910) 
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: The group total category refers to all respondents within the age group.  
Source: OE elaboration from online survey data 

The socio-demographic breakdown for the 18-25 age group is shown in Table 54, and those of the 
26+  age  group  in  Table  55.  Both  age  groups  evidenced  similar  profiles.  The  age  groups  were 
relatively  gender  balanced;  users  of  e-cigarettes  were  predominately  male  in  both  age  groups. 
Females in the 18-25 age group were more likely to have experimented with the product or to never 
have used it, whereas no differences in gender were observed for the 26+ age group.  

In the 18-25 age group, the majority of the respondents had a medium level of education – at least 
high school-level education – on account of the fact that 42% of respondents reported that they were 
students (see section 1.3.3). The education levels were relatively consistent across different types of 
users.  In terms of place  of  residency, a large  majority of respondents resided in urban areas (e.g. 
66% in the 26+ age group). Never users had a higher share of rural residents than current users or 
the overall group breakdown. In terms of economic status, most respondents in the 18-25 age group 
and the 26+ age group self-reported a medium status, but the current users had a greater share of 
self-reported high economic status.  

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Table 54. E-cigarette use socio-demographic breakdown (18-25 age group) 

Percentage and number of respondents in the 18-25 age group 

Group total  
% (n) 

Current users  
% 

Past users  
% 

Used once or twice  
% 

Never users 
% 

15 

15 

25 

45 

Use of product 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 
(6,090) 

47 
(2,869) 

53 
(3,221) 

5 
(335) 

63 
(3,829) 

32 
(1,926) 

65 
(3,949) 

19 
(1,173) 

16 
(968) 

19 

11 

20 

14 

16 

15 

16 

13 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

18 
(1,126) 

65 
(3,954) 

17 
(1,010) 

11 

14 

24 

19 

13 

20 

16 

13 

15 

16 

13 

17 

14 

18 

23 

26 

20 

27 

22 

26 

21 

25 

28 

28 

18 

38 

49 

40 

44 

47 

43 

42 

56 

50 

45 

41 

Base: all respondents in the 18-25 age group (N=6,090) 

Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  
*  The  sub-categories  of  the  education  level  were  the  following:  (1)  No  official  education;  (2)  Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 

Source: OE elaboration from online survey data 

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Table 55. E-cigarette use socio-demographic breakdown (26+ age group) 

 Percentage and number of respondents in the 26+ age group) 

Group total  
% (n) 

Current users  
% 

Past users  
% 

Used once 
or twice 
% 

Never used 
% 

Use of product 

Gender 

Male 

Female 

Education level * 

1-2 (low) 

3-4 (medium) 

5-6 (high) 

Residency 

Urban 

Suburban 

Rural 

100 

(5910) 

52 

(3074) 

48 

(2836) 

5 

(308) 

46 

(2704) 

49 

(2898) 

66 

(3879) 

17 

(1010) 

17 

(1021) 

Self-reported socio-economic status 

1-4 (low) 

5-7 (medium) 

8-10 (high) 

23 

(1374) 

64 

(3769) 

13 

(767) 

18 

11 

16 

56 

21 

15 

20 

15 

20 

20 

18 

12 

13 

17 

31 

12 

10 

0 

11 

10 

12 

12 

6 

9 

11 

15 

15 

17 

20 

15 

16 

17 

12 

12 

17 

16 

15 

54 

58 

60 

37 

53 

52 

59 

71 

61 

56 

46 

Base: all respondents in the 26+ age group (N=5,910) 

Notes: The group total column refers to all respondents within the age group, i.e. it is a within column 
percentage. It provides the breakdown of each socio-demographic variable, including absolute numbers. 
The white cells in the four right columns represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100).  

* The sub-categories of the education level were the following: (1) No official education; (2) Primary 
school; (3) High school; (4) Some years of university (not completed); (5) University degree completed; 
(6) Post-graduate (master, PhD, other) 

Source: OE elaboration from online survey data 

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6.2.2 Pattern of use  

In  the  online  survey,  a  majority  of  current  e-cigarette  users  in  the  18-25  age  group  (see  Figure 
132.) and the 26+ age group (see Figure 133) used the product daily, with 61% and 68% providing 
this response respectively. When considered relative to the total sample, these shares become much 
smaller but nevertheless considerable: 9% of respondents in the 18-25 age group were daily users of 
the e-cigarettes, and 12% in the 26+ age group. Over a quarter reported doing so about once a week 
in both group samples. In the 18-25 age group, less than one in ten used them once a month or less 
(9%). This share was lower in the 26+ age group at 6% using it once a month or less. 

Figure 132. Frequency of use of current e-cigarette users (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of electronic cigarettes in the 18-25 age group (N=919) 
Question: Q.1.3. How often do you use e-cigarettes? 
Source: OE elaboration from online survey data 

Figure 133. Frequency of use of current e-cigarette users (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of electronic cigarettes in the 26+ age group (N=1,051) 
Question: Q.1.3. How often do you use e-cigarettes? 
Source: OE elaboration from online survey data 

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The consumption patterns of past e-cigarette users in the 18-25 age group were different to those 
of current users (see Figure 134). The percentage of past daily users was 41% compared to 61% for 
current users. In the 26+ age group, 55% were past daily users compared to 68% for current users. 
This  trend  is  consistent  with  the  commentary  from  the  focus  groups.  Participants  identified  e-
cigarettes  as  an  aid  to  reduce  or  quit  another  tobacco  product.  The  level  of  nicotine intake  can  be 
progressively decreased, until users were able to get rid of the addiction or the craving for tobacco. It 
suggests  that  participants  mainly  use  ‘open-system’  e-cigarettes  as  this  feature  is  not  available  in 
‘closed systems’. However, it may not be an effective tool for all users:  

“And the search for a sensation that is stronger and stronger! It’s a crescendo! Because 
we can start with the e-cigarette at zero nicotine and then we will put some nicotine in it 
as we don’t find what we had was enough and then we keep going higher.” (F, 49, FR) 

Figure 134. Frequency of use of past e-cigarette users (18-25 age group) 

Percentage and number of past users in the 18-25 age group 

Base: past users of electronic cigarettes in the 18-25 age group (N=917) 
Question: Q.1.6. How often did you use e-cigarettes? 
Source: OE elaboration from online survey data 

Figure 135. Frequency of use of past e-cigarette users (26+ age group) 

Percentage and number of past users in the 26+ age group 

Base: past users of electronic cigarettes in the 26+ age group (N=628) 
Question: Q.1.6. How often did you use e-cigarettes? 
Source: OE elaboration from online survey data 

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Current users were also asked about the number of puffs per session. The average number of puffs 
taken per session in the 18-25 age group was 13 puffs (see Figure 136). The histogram is skewed 
to the right, indicating that consumers usually inhale less than 10 puffs per session. Current users in 
the 26+ age group followed the same pattern (see Figure 137), with 12 puffs per session on average. 

Figure 136. Average number of puffs per session (18-25 age group) 

Number of current users of e-cigarettes in the 18-25 age group 

Base: current users of electronic cigarettes in the 18-25 age group (N=919) 
Question: Q.1.4.b. On average, how many puffs do you take during a vaping session? 
Source: OE elaboration from online survey data 

Figure 137. Average number of puffs per session (26+ age group) 

Number of current users in the 26+ age group 

Base: current users of electronic cigarettes in the 26+ age group (N=1,051) 
Question: Q.1.4.b. On average, how many puffs do you take during a vaping session? 
Source: OE elaboration from online survey data 

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Figure 138 and Figure 139 show the number of sessions per day for current users. 52% of current 
users in the 18-25 age group reported 1 to 5 sessions per day; 45% of the 26+ age group reported 
similarly.122  

Figure 138. Average number of sessions per day of use (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of electronic cigarettes in the 18-25 age group (N=919) 
Question: Q.1.4.c. On the days that you vape, about how many vaping sessions do you have? 
Source: OE elaboration from online survey data 

Figure 139. Average number of sessions per day (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of electronic cigarettes in the 26+ age group (N=1051) 
Question: Q.1.4.c. On the days that you vape, about how many vaping sessions do you have? 
Source: OE elaboration from online survey data 

122 The correlation between the number of puffs and the number of sessions for the 18-25 age group at 0.21 (p-value <0.01) 
was  statistically  significant.  In  comparison,  the  correlation  for  the  respondents  in  the  26+  age  group  was  smaller  and 
insignificant (corr= 0.05, p-value=0.07). The findings suggested that the intensity of use of vaping sessions (i.e. the number 
of puffs) increased with the number of sessions of vaping per day of use, particularly for the 18-25 age group. 

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Figure 140 and Figure 141 show the reported number of sessions for daily e-cigarette users. While in 
both  age  groups  1-5  sessions  daily is  the  highest  percentage,  42%  of  the  18-25  age  group,  and 
47% of the 26+age group reported between 6 and 20 sessions daily – an indication of addiction? 

Figure 140. Number of sessions per day, for daily users (18-25 age group) 

Percentage and number of current daily users in the 18-25 age group) 

Base: daily current users of electronic cigarettes in the 18-25 age group (N=560) 
Question: Q.1.4.c. On the days that you vape, about how many vaping sessions do you have? 
Source: OE elaboration from online survey data 

Figure 141. Number of sessions per day, for daily users (26+ age group) 

Percentage and number of current daily users in the 26+ age group) 

Base: daily current users of electronic cigarettes in the 26+ age group (N=714) 
Question: Q.1.4.c. On the days that you vape, about how many vaping sessions do you have? 
Source: OE elaboration from online survey data 

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On average, respondents that were 18 years old had used e-cigarettes for approximately 1.5 years – 
since they were 16 years old. Indeed, for respondents between the ages of 18 and 21, the average 
starting age was below 18 years. E-cigarettes were introduced to Europe in 2006 and the survey data 
showed that most respondents over the age of 30 had begun using e-cigarettes around 5 or 6 years 
ago, suggesting that the market reached maturity around 2014.  

Figure 142. Initiation of use for current and past e-cigarette users (total sample) 

(number of current and past users in the overall sample) 

Base: current and past users of electronic cigarettes in the total sample (N=3,221123) 
Question: Q.1.2.a. At about what age did you start using the products below? & Q.5.2. Age 
Note: The figure illustrates the approximate starting age of e-cigarette use among all respondents of the 
online survey, where the x-axis represents the current age of the respondent (Q.5.2) and the y-axis is the 
average  numbers  of  years  of  product  consumption  (calculated  by  subtracting  the  current  age  from  the 
starting age). The orange line represents the 45º or 18 y.o. line. Each blue point represents the average 
starting age for respondents of that age; points above the 18 y.o. line reveal those initiating consumption 
of e-cigarettes before the age of 18, while those below the line reveal age brackets starting consumption 
after the age of 18 on average. The blue lines represent the mean standard deviation, i.e. it does not show 
the full range of values for each age.   
Source: OE elaboration from online survey data 

Figure 143 and Figure 144 show the average duration of use of e-cigarettes for past users. Two years 
for the 18-25 age group and three years for the 26+ age group.  For both groups, the histograms 
are  skewed  towards  the  lower  number  of  years,  indicating  a  short  period  of  use  of  the  product. 
Whether this evidenced successful cessation of e-cigarettes and other tobacco products or a switch 
back to conventional cigarettes is discussed in Table 58 and Table 59.  

123 NA and misreported values are excluded. 

193 

18 y.o. line  
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 143. Duration of use of past e-cigarette users (18-25 age group) 

Number of past users in the 18-25 age group 

Base: past users of electronic cigarettes in the 18-25 age group (N=837124) 
Question: Q.1.2.a. At about what age did you start using e-cigarettes? & Q.1.2.b. At about what age did 
you stop using e-cigarettes? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was a past 
user of the product. The mean shows the average duration of use. We cut off the data at 13 years, since 
the product was introduced in 2006. 
Source: OE elaboration from online survey data 

Figure 144. Duration of use of past e-cigarette users (26+ age group) 

Number of past users in the 26+ age group 

Base: past users of electronic cigarettes in the 26+ age group (N=564125) 
Question: Q.1.2.a. At about what age did you start using e-cigarettes? & Q.1.2.b. At about what age did 
you stop using e-cigarettes? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was a past 
user of the product. The mean shows the average duration of use. We cut off the data at 13 years, since 
the product was introduced in 2006. 
Source: OE elaboration from online survey data 

124 NA and misreported values are excluded. 
125 NA and misreported values are excluded. 

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Current and former e-cigarette users were asked about the reasons for starting to use the product. In 
the 18-25 age group (see Figure 145) 38% cited “for enjoyment,” 33% because they were trying to 
quit  or  reduce  the  consumption  of  another  tobacco  product  and  22%  ‘to  socialise  and  its  trendy”. 
Furthermore, 15% reported starting due to advertisements. In the 26+ age group (see Figure 146) 
54% reported that they has begun to use e-cigarettes to stop or reduce the consumption of another 
tobacco product, 28% cited for ‘enjoyment’ and 19% attributed it to advertisements. The key driver 
for young people was enjoyment while for older respondents it was health.  

Figure 145. Initiation of e-cigarette use: reasons (18-25 age group) 

Percentage and number of current and past users in the 18-25 age group) 

Base: current and past users of electronic cigarettes in the 18-25 age group (N=1,836)  
Question: Q.2.1.a. Why did you start using e-cigarettes? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because respondents could select more than one term.  
Source: OE elaboration from online survey data 

Figure 146. Initiation of e-cigarette use: reasons (26+ age group) 

Percentage and number of current & past users in 26+ age group 

Base: current and past users of electronic cigarettes in the 26+ age group (N=1,679)  
Question: Q.2.1.a. Why did you start using e-cigarettes? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because respondents could select more than one term.  
Source: OE elaboration from online survey data 

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The same question about reasons for trying e-cigarettes was asked of those who had only tried them 
once or twice. For the 18-25 age group (see Figure 147) 41% cited enjoyment, 30% to socialise or 
that it was trendy and 17% because everyone else was using e-cigarettes – essentially social reasons. 
The 26+  age  group (see Figure  148) health  was the dominant motivation with 47% saying were 
trying  to  quit  or  reduce  the  consumption  of  another  tobacco  product.  Around  one  in  five  cited 
enjoyment, socialising and advertisements. 

These findings resonate with comments in focus groups. Several features of e-cigarettes allowed the 
product to be viewed as an aid to quitting or cutting down. The open-tank system e-cigarettes allow 
users to customise the amount of nicotine intake and the number of puffs taken for each session. This 
to progressively decrease the nicotine content and reduce the craving for tobacco consumption. The 
sense of control over the product may translate into a feeling of reduced harmfulness. Yet, it may not 
always appear to be an effective tool. 

“I myself decide on the taste and the level of nicotine and prepare the liquid. A bit like a 
chemist.” (M, 24, BG) 

“You can control the dose more easily. […] you can give three puffs and stop. For example, 
in  my  case...  I  go  to  the  terrace  and  give  this  a  few  puffs…  You  can  control  the nicotine 
intake much more.” (M, 34, ES) 

“This is to get rid of the craving… That's if you want to stop smoking, instead of a patch, 
you give this a few puffs… because it also helps you with the habit of inhaling and exhaling 
smoke.” (M, 28, ES) 

“Mainly because it was somewhat trendy, I was infected by young people and also wanted 
electronic,  I  wanted  to  change  and  see  if  I  could  stop.  On  the  contrary,  I  returned  to 
cigarettes.” (M, 20, EL)  

Figure 147. Initiation of e-cigarette use: reasons (18-25 age group) 

Percentage and number of those who tried once or twice in the 18-25 age group 

Base: those who tried to use electronic cigarettes in the 18-25 age group (N=1,537)  
Question: Q.2.1.b. Why did you try e-cigarettes? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from study survey data 

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Figure 148. Initiation of e-cigarette use: reasons (26+ age group) 

Percentage and number of those who tried once or twice in the 26+ age group 

Base: those who tried to use electronic cigarettes once or twice in the 26+ age group (N=922)  
Question: Q.2.1.b. Why did you try e-cigarettes? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

E-cigarette users were asked whether they had tried to quit. In the 18-25 age group, 53% of current 
users reported having never attempted to quit e-cigarette use. 25% had tried to quit once and the 
remaining 22% had tried twice or more times. (see Figure 149). 64% of current users in the 26+ age 
group  had  never  attempted  to  quit,  17%  reported  that  they  had  tried  to  quit  once  and  20%  had 
attempted to quit at least twice in the past (see Figure 150). 

Figure 149. Cessation: attempts to quit e-cigarettes (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of electronic cigarettes in the 18-25 age group (N=919)  
Question: Q.1.5. Have you ever tried to quit e-cigarettes? If yes, how many times? 
Source: OE elaboration from online survey data 

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Figure 150. Cessation: attempts to quit e-cigarettes (26+ age group) 

Percentage and number of current users in the 26+ age group 

Base: current users of electronic cigarettes in the 26+ age group (N=1,051)  
Question: Q.1.5. Have you ever tried to quit e-cigarettes? If yes, how many times? 
Source: OE elaboration from online survey data 

For the 18-25 age group (see Figure 151) health was the dominant reason for trying to quit. 28% 
cited  health,  11%  health  warning  messages  and  15%  were  concerned  about  ‘the  health  of  people 
around me’. About one in five cited economic reasons and ‘not liking it anymore’. A similar pattern 
emerged  in  the  26+  age  group  (see  Figure  152):  41%  cited  health  reasons  and  health  warning 
messages, and 10% concerns about passive smoking.  

Figure 151. Cessation: reasons for trying to quit e-cigarette use (18-25 age group) 

Percentage and number of current users in the 18-25 age group 

Base: current users of electronic cigarettes that tried to quit in the 18-25 age group (N=436)  
Question: What made you try to quit e-cigarettes? Please select the most fitting answer. 
Note: Respondents were asked to provide only one option. Therefore,  each bar represents the share of 
respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

198 

 
 
 
 
 
 
 
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Figure 152. Cessation: reasons for trying to quit e-cigarette use (26+ age group) 

 Percentage and number of current users in the 26+ age group 

Base: current users of electronic cigarettes that tried to quit in the 26+ age group (N=384)  
Question: What made you try to quit e-cigarettes? Please select the most fitting answer. 
Note: Respondents were asked to provide only one option. Therefore,  each bar represents the share of 
respondents that selected the option within the age group. 
Source: OE elaboration from online survey data 

A number of reasons for re-starting e-cigarette use after an attempt to quit were reported. In the 18-
25 age group (see Figure 153) 28% cited stress, 22% that it was difficult to stop and 22% that is 
was healthier than other tobacco products. Almost one in five said they really did not want to stop or 
that  it  was  due  to  their  social  environment.  The  26+  age  group  (see  Figure  154)  cited  the  same 
issues.  ‘Stress  25%,  difficulty  24%  and  healthier  than  other  tobacco  products  22%.  As  with  the 
younger  group  about  one  in  five  said  that  they  really  did  not  want  to  stop  or  that  the  social 
environment was the reason. 

Figure 153. Reasons for starting to use e-cigarettes again (18-25 age group) 

Percentage and number of current users that had attempted to quit in the 18-25 
age group 

Base: current users of electronic cigarettes that tried to quit in the 18-25 age group (N=436)  
Question: Q.2.3. Why did you start to use e-cigarettes again? Please select up to 2 options.  
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

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Figure 154. Reasons for starting to use e-cigarettes again (26+ age group) 

Percentage and number of current users that had attempted to quit in the 26+ age 
group 

Base: current users of electronic cigarettes that tried to quit in the 26+ age group (N=384)  
Question: Q.2.3. Why did you start to use e-cigarettes again? Please select up to 2 options.  
Note: Each bar represents the share of respondents that selected the option within the age group. The 
percentages do not add up to 100% because of the fact that respondents could select more than one term 
– therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

6.2.3 Parallel use with other tobacco and related products 

In the 18-25 age group, 74% of current e-cigarette users were dual users, i.e. they also used other 
tobacco  and  related  products  in  parallel  (see  Table  56).  The  greater  majority  were  also  smoking 
conventional cigarettes. Close to one fifth of current users (18%) indicated that they had previously 
used other products but were now only using e-cigarettes. Less than one in ten (8%) had only ever 
used e-cigarettes. The same pattern was found for the  26+ age group (see Table 57). Here 78% 
were dual users and 90% reported smoking traditional cigarettes.  

These  findings  on  dual  use  resonate  with  the  focus  group  discussions.  People  said  that  the  main 
purpose  for  using  e-cigarettes  was  to  quit  conventional  cigarettes;  to  alternate  e-cigarettes  with 
conventional tobacco products in order to reduce consumption of the latter; to use the e-cigarette in 
places where smoking was not allowed but e-cigarettes were tolerated (at some work places, bars, 
malls, etc. , also depending on the country); or, to use in places where smoking is not forbidden, but 
it  was  preferable  not  to  smoke  in  order  to  avoid  harming  others  (e.g.  at  home)  –  the  latter  was 
particularly relevant for those with children.  

The online survey findings suggested that the e-cigarettes as a tool for cessation is not a magic bullet. 
Only  18%  of  respondents  managing  to  consume  only  e-cigarettes  after  having  used  other  tobacco 
products in the past.  

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Table 56. Career flows of use for current e-cigarette users (18-25 age group) 

 Number and percentage of current users in the 18-25 age group  

Never users of other products  

Total 

Exclusive current user of e-cigarettes & past user of other product(s)  

Out of them, switching from (one or more products) * 

Number  % 

919 

77 

164 

100 

8 

18 

Cigarettes 

Slim cigarettes 

Waterpipe tobacco  

Small cigarillos 

HTPs 

(n=143) 

87% * 

(n=51) 

(n=50) 

(n=32) 

(n=29) 

31% * 

30% * 

19% * 

18% * 

Current user of e-cigarettes & both current and past user of other product(s)  

678 

74 

Other products consumed in parallel now (one or more products) *  

Cigarettes 

(n=555) 

82% * 

Slim cigarettes 

(n=274) 

40% * 

Waterpipe tobacco  

(n=281) 

41% * 

Small cigarillos 

(n=218) 

32% * 

HTPs 

(n=277) 

41% * 

Base: current users of e-cigarettes in the 18-25 age group (N=919) 

Question: Q.1.1. Have you ever used e-cigarettes? 

Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  

(*) Percentages add up to more than 100% on account of the prevalence of dual use.  

Source: OE elaboration from online survey data 

201 

 
 
 
 
 
 
 
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Table 57. Career flows of current e-cigarette users (26+ age group) 

 Number and percentage of current users in the 26+ age group 

Never users of other products 

Total 

Exclusive current user of e-cigarettes & past user of other product(s) 

Out of them, switching from (one or more products)  

Number 

1051 

41 

189 

% 

100 

4 

18 

Cigarettes 

Slim cigarettes 

Waterpipe tobacco  

Small cigarillos 

HTPs 

(n=177) 

94% * 

(n=43) 

(n=47) 

(n=26) 

(n=31) 

25% * 

23% * 

16% * 

14% * 

Current user of e-cigarette & both current and past user of other product(s)  

821 

78 

Other products consumed in parallel now (one or more products) *  

Cigarettes 

HTPs 

Slim cigarettes 

Small cigarillos 

(n=736) 

90% * 

(n=362) 

44% * 

(n=284) 

35% * 

(n=231) 

28% * 

Waterpipe tobacco  

(n=202) 

25% * 

Base: current users of electronic cigarettes in the 26+ age group (N=1,051)  

Question: Q.1.1. Have you ever used e-cigarettes? 

Note:  Patterns  of  use  and  consumption  careers  are  explored  for  different  consumer  profiles  of  current 
users. A breakdown is provided for the two variables of interest, i.e. current parallel use patterns. The last 
row only provides the breakdown of current dual use as this is the variable of interest; it does not include 
a  breakdown  that  takes  account  past  consumption  of  products  to  avoid  confusion  (from  too  many 
permutations).  

(*) Percentages add up to more than 100% on account of the prevalence of dual use.  

Source: OE elaboration from online survey data 

Figure 155 and Figure 156 provide a visual representation of the career flows for current users of e-
cigarettes.  The  objective  of  the  figures  is  to  highlight  dual  use  patterns,  and  as  such  exclusive  e-
cigarette users and those not using other products were excluded. In the visualisation the thickness 
of the tails is only indicative. As previously noted, a majority of current e-cigarette users in the 18-
25 age group were dual users of tobacco products; in the main conventional cigarettes (see Figure 
155). The visualisation for the 26+ age group (see Figure 156) showed that the majority of current 
e-cigarette users had also used other tobacco products in the past, but there is a lower level of current 
dual  use.  The  finding  supports  the  hypothesis  that  e-cigarettes  were  perceived  more  strongly  as  a 
cessation tool among the 26+ age group, while the younger generations may be influenced by trends, 
potentially supporting the gateway theory (see Figure 145 and Figure 146 on reasons for initiation of 
use).  

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Figure 155. Representation of career flows for current e-cigarette users (18-25 age group) 

Base: current users of e-cigarettes (excluding never users of other products) in the 18-25 age group (N=842) 
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: The diagram is a simplified version of the career flows of dual e-cigarette users. The thickness/width of 
the tails, as well as the percentages included, are only indicative. Some individuals may be represented twice 
(or more) if they use/have used more than one product at a time. The diagram highlights dual use patterns 
as well as transitions to/from other products; therefore, never users of other products were excluded.  
Source: OE elaboration from online survey data 

Figure 156. Representation of career flows for current e-cigarette users (26+ age group) 

Base: current users of e-cigarettes (excluding never users of other products) in the 26+ age group (N=1,010)  
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: The diagram is a simplified version of the career flows of dual e-cigarette users. The thickness/width of 
the tails, as well as the percentages included, are only indicative. Some individuals may be represented twice 
(or more) if they use/have used more than one product at a time. The diagram highlights dual use patterns 
as well as transitions to/from other products; therefore, never users of other products were excluded. Source: 
OE elaboration from online survey data 

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Table 58 and Table 59 show the career flows of past users of e-cigarettes. In the 18-25 age group, 
24% of past e-cigarette users appeared to have used the product as a cessation aid tool successfully, 
having  stopped  consuming  other  tobacco  products  at  the  time  of  the  survey.  There  were  23% 
exclusive past e-cigarette users that had transitioned to other tobacco products, with most switching 
to conventional cigarettes. In the 26+ age group, of former users of e-cigarettes 23%had stopped 
consuming  tobacco  products  while  43%  of  had  switched  to  other  tobacco  products  –  mainly 
conventional cigarettes. It is also of particular note that in the 18-25 age group, 23% exclusive past 
users of e-cigarettes (i.e. never users of other tobacco products) were now consuming other products. 
Of these 87% reported smoking traditional cigarettes. In the 26+ age group, 31% exclusive past e-
cigarette  users  were  now  dual  users  of  whom  96%  reported  smoking  traditional  cigarettes.  These 
findings point to the conclusion that for some people at any age e-cigarettes may serve as a gateway 
product. The focus groups hint at a possible explanation. It was said that e-cigarettes are not very 
satisfying and did not give the pleasures associated with smoking a conventional cigarette. They are 
not a substitute for a traditional cigarette and as such have limited appeal as an aid to quitting (see 
section 6.3). The findings of the survey appear to confirm the view that e-cigarettes may not always 
be an effective aid to quitting. 23% of past users managed to quit all tobacco and related products in 
the 26+ age group.  

Table 58. Career flow of past e-cigarette users (18-25 age group) 

 Number and percentage of past users in the 18-25 age group 

Never user of other products  

Dual past user & not using any products now 

Total 

Exclusive  past  user  of  e-cigarettes  &  current  user  of  other  products  (but  not  e-
cigarettes) 

Out of them, switching to (one or more products) * 

Number 

 % 

917 

100 

63 

223 

215 

7 

24 

23 

Cigarettes 

Slim cigarettes 

Waterpipe tobacco  

Small cigarillos 

(n=188) 

87% * 

(n=43) 

(n=36) 

(n=24) 

20% * 

17% * 

11% * 

HTPs 

(n=17) 

8% * 

Dual past user & current user of other products (but not e-cigarettes)  

416 

45 

Other products currently consumed in parallel (one or more products) * 

Cigarettes 

Slim cigarettes 

HTPs 

Waterpipe tobacco  

Small cigarillos 

(n=314) 

75% * 

(n=95) 

(n=87) 

(n=82) 

(n=55) 

23% * 

21% * 

20% * 

13% * 

Base: past users of e-cigarettes (excluding never users of other products) in the 18-25 age group (N=917)  
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. A 
breakdown is provided for the variables of interest, i.e. those who continued using other tobacco products 
after using e-cigarettes. The last row only provides the breakdown of current consumption because this is the 
variable of interest; it does not include a breakdown that takes account past consumption of products to avoid 
confusion (from too many permutations).  
(*) Percentages add up to more than 100% on account of the prevalence of dual use.  
Source: OE elaboration from online survey data 

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Table 59. Career flows of past e-cigarette users (26+ age group) 

 Number and percentage of past users in the 26+ age group 

Never users of other products 

Dual past user & not using any products now 

Total 

Exclusive past user of e-cigarettes & current user of other products (but not e-
cigarettes) 

Out of them, switching to (one or more products) * 

Number 

 % 

628 

16 

144 

198 

100 

2 

23 

31 

Cigarettes 

Slim cigarettes 

Waterpipe tobacco  

Small cigarillos 

(n=191) 

96% * 

(n=40) 

(n=38) 

(n=19) 

20% * 

19% * 

10% * 

HTPs 

(n=11) 

6% *  

Dual past user & current user of other products (but not e-cigarettes) 

270 

43 

Other products currently consumed (one or more products) * 

Cigarettes 

Slim cigarettes 

HTPs 

Waterpipe tobacco  

Small cigarillos 

(n=202) 

75% * 

(n=70) 

(n=73) 

(n=45) 

(n=37) 

26% * 

27% * 

17% * 

14% * 

Base: past users of e-cigarettes in the 26+ age group (N=628)  

Question: Q.1.1. Have you ever used e-cigarettes? 

Note: Patterns of use and consumption careers are explored for different consumer profiles of past users. 
A  breakdown  is  provided  for  the  variables  of  interest,  i.e.  those  who  continued  using  other  tobacco 
products  after  using  e-cigarettes.  The  last  row  only  provides  the  breakdown  of  current  consumption 
because  this  is  the  variable  of  interest;  it  does  not  include  a  breakdown  that  takes  account  past 
consumption of products to avoid confusion (from too many permutations).  

(*) Percentages add up to more than 100% on account of the prevalence of dual use.  

Source: OE elaboration from online survey data 

Figure 157 and Figure 158 provide a visual representation of dual product use behaviours. Most past 
users of e-cigarettes in both the 18-25 age group and the 26+ age group were dual users. It is 
important to note that the ‘past’ tail in the figures includes both dual users and those that switched 
between  products.  A  majority  of  the  past  users  still  using  other  tobacco  and  related  products  had 
transitioned to cigarettes, as displayed by the thicker “present” tails in both age groups. Again, this 
resonates  with  comments  from  the  focus  group  participants  who  noted  that  e-cigarettes  were  not 
always  very  satisfying,  that  the  consumption  of  tobacco  by  methods  other  than  burning  were  not 
expected  to  calm  one  down,  and  that  the  smoking  ritual  was  experienced  as  “colder”  emotionally-
speaking (see section 6.3).  

205 

 
 
 
 
 
 
 
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Figure 157. Representation of career flows for past e-cigarette users (18-25 age group) 

Base: past users of e-cigarettes (excluding never users of other products) in the 18-25 age group (N=854)  
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: The diagram is a simplified version of the career flows of dual e-cigarette users. The thickness/width of 
the tails, as well as the percentages included, are only indicative. Some individuals may be represented twice 
(or more) if they use/have used more than one product at a time. The diagram highlights dual use patterns 
as well as transitions to/from other products; therefore, never users of other products were excluded.  
Source: OE elaboration from online survey data 

Figure 158. Representation of career flows for past e-cigarette users (26+ age group) 

Base: past users of e-cigarettes (excluding never users of other products) in the 26+ age group (N=612) 
Question: Q.1.1. Have you ever used e-cigarettes? 
Note: The diagram is a simplified version of the career flows of dual e-cigarette users. The thickness/width of 
the tails, as well as the percentages included, are only indicative. Some individuals may be represented twice 
(or more) if they use/have used more than one product at a time. The diagram highlights dual use patterns 
as well as transitions to/from other products; therefore, never users of other products were excluded.  
Source: OE elaboration from online survey data 

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6.3  Consumer perception 

From the focus group discussions eight words or word combinations that people used to describe e-
cigarettes  were  selected;  four  were  positive  associations  and  four  negative.  The  associations  were 
complicated, unhealthy, costly, addictive, practical, modern/technological, elegant/trendy/fashionable 
and enjoyable.  

In  the  online  survey  respondents  were  asked  which  of  the  words  best  captured  what  they  thought 
about  e-cigarettes.  The  results  are  shown  in  Table  60  and  Table  61.  In  both  age  groups  the  most 
frequent associations were ‘unhealthy’, ‘addictive’ and ‘modern/technological’. A striking finding is the 
difference  in  perceptions  of  the  current  users  and  never  users  of  e-cigarettes.  For  the  18-25  age 
group a comparison between current and never users showed that 52% of the never users selected 
‘unhealthy’ and 43% more chose ‘addictive’. Similar differences were found in the 26+ age group in 
which  64%  more  never  users  selected  unhealthy  and  54%  more  selected  addictive.  In  terms  of 
positive associations, there was a curious finding for ‘elegant/trendy/fashionable’: 10% more 18-25 
age group never users chose this association as did 23% more in the 26+ age group. 

Table 60. Perception of e-cigarettes (18-25 age group) 

Percentage and number of respondents in the 18-25 age group 

Never used 

Use of product 

Complicated 

Unhealthy 

Costly 

Addictive 

Practical 

Modern/technological 

Group 
total 

%(n) 

100 

(6090) 

11 

(640) 

41 

(2515) 

26 

(1608) 

37 

(2281) 

24 

(1435) 

41 

(2507) 

Elegant/trendy/fashionable 

31 

Enjoyable 

(1907) 

25 

(1518) 

Current 
users 

% 

15 

16 

6 

10 

10 

22 

15 

16 

25 

Past users 

% 

15 

16 

11 

53 

12 

17 

15 

14 

20 

Used once 
or twice 

% 

25 

25 

26 

14 

25 

26 

29 

29 

30 

Base: all respondents in the 18-25 age group (N=6,090) 
Question:  Q.4.10.  Which  of  the  following  words  best  captures  what  you  think  about  vaping  electronic 
cigarettes? Please tick as many boxes as you would like.  
Note:  Respondents  could  provide  multiple  answers.  The  group  total  category  refers  to  the  total 
respondents in that age group. The orange column represents the proportion of respondents in the age 
group  that  selected  the  response  option  (i.e.  11%  of  respondents  in  the  18-25  age  group  responded 
“complicated”).  The white  cells  (in  the  four right  columns)  represent  the  breakdown by  user  type,  i.e. 
they are within row percentages (white cells in each row sum to 100). 
Source: OE elaboration from online survey data 

% 

45 

42 

58 

23 

53 

35 

42 

42 

25 

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Table 61 Perception of e-cigarettes (26+ age group)  

Percentage and number of respondents in the 26+ age group 

Use of product 

Complicated 

Unhealthy 

Costly 

Addictive 

Practical 

Modern/technological 

Group 
total 

%(n) 

100 

(5910) 

11 

(643) 

46 

(2744) 

26 

(1526) 

36 

(2136) 

20 

(1205) 

36 

(2134) 

Elegant/trendy/fashionable 

23 

Enjoyable 

(1353) 

16 

(937) 

Current 
users 

% 

18 

12 

7 

9 

12 

35 

22 

23 

46 

Past users 

% 

11 

14 

7 

9 

8 

13 

11 

11 

15 

Used once 
or twice 

% 

16 

17 

15 

18 

14 

18 

17 

20 

15 

Never used 

% 

56 

56 

71 

64 

66 

33 

49 

46 

24 

Base: 26+ age group (N=5,910) 
Question:  Q.4.10.  Which  of  the  following  words  best  captures  what  you  think  about  vaping  electronic 
cigarettes? Please tick as many boxes as you would like.  
Note: Respondents could provide multiple answers. The group total category refers to the total respondents 
in  that  age  group.  The  orange  column  represents  the  proportion  of  respondents  in  the  age  group  that 
selected the response option (i.e. 11% of respondents in the 18-25 age group responded “complicated”). 
The white cells (in the four right columns) represent the breakdown by user type, i.e. they are within row 
percentages (white cells in each row sum to 100). 
Source: OE elaboration from online survey data 

The focus group participants, users of various tobacco products, expected e-cigarettes to be better 
tolerated in society because they “do not produce smoke, nor does it smell bad”. Not causing nuisance 
to  others  was  stated  as  a  key  factor  for  social  acceptance.  It  also  allowed  users  not  to  identify 
themselves as “real” smokers.  

“I see loads of young people that want to differentiate themselves, that want to be a 
little Avant Garde (…).” (M, 33, FR) 

“You  were  no  longer  a  smoker  but  a  vaper.  You  wanted  to  get  away  from  the  group  of 
smokers and no longer belong to them. You wanted to be a vaper.” (M, 22, DE) 

“Lately I use vape and I think this group has more positives than the other. I do not smell 
that much, my teeth, fingers, nails do not become yellow, I do not cough and do not produce 
coughing secretions.” (M, 24, BG)   

“Too much technology (referring to using electronic devices to smoke) ... I prefer to smoke 
and that's it, (but) you don't bother the person next to you (e-cigarettes).” (M, 52, ES) 

“I think that the electronic cigarette is accepted, it’s not the same. I find that the vapour 
can smell pleasant compared to that of the cigarette.” (M, 28, FR) 

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 “I’ve tried the e-cigarette because of the price, but I was too lazy to charge the battery all 
the time and go out and buy the liquids…Now I'm switching between roll-your-own tobacco 
and cigarettes” (M, 22, DE) 

“My need of cigarettes is not satisfied by the liquid as I have to wait for some time for it to 
recharge in order to be able to smoke. This is a disadvantage.” (F, 50, BG) 

Participants in the focus group argued that marketing techniques had exploited the flavours and design 
features  of  the  product  to  target  younger  generations  (see  also  section  6.2).  Participants  also 
suggested  that  using  the  product  might  encourage  young  people  to  start  using  other  tobacco  and 
related products; in other  words, they believed there may be a gateway effect associated with the 
product (see section 6.1).  

“The flavours were made to attract kids, so they start smoking a lot sooner, so they like the 
flavour compared to having their first cigarette.” (M, 33, DE) 

“It  has  penetrated  young  people  so  much,  I  see  it  with  my  son,  they  put  up  things  in 
Instagram and such, […] it is very trendy.” (F, 43, EL) 

“Maybe very young people, who are 16 or 17. Some start with this, they don't all start with 
conventional tobacco.” (M, 31, ES) 

“It's innovative so I wanted to try it out and see what it's like.” (M, 22, DE) 

In the survey 71% of the 18-25 age group agreed that using e-cigarettes might encourage people to 
start  smoking/using  other  tobacco  and  related  products  (see  Figure  159).  On  this  issue  there  is  a 
striking difference between the current and never users: 28% more of the never users said ‘definitely 
yes’ to the gateway effect. In the 26+ age group (see Figure 160) 67% agreed about the possibility 
of the gateway effect and 38% more of the never users than current users said ‘definitely yes’ to the 
gateway effect.  

Figure 159. Perceived gateway effect of e-cigarettes (18-25 age group)  

Percentage and number of respondents in the 18-25 age group

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.9.  Do  you  think  that vaping  electronic cigarettes  might  encourage people  to start 
smoking/using other tobacco products, or not?  
Source: OE elaboration from online survey data 

209 

 
 
 
 
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Figure 160. Perceived gateway effect of e-cigarettes (26+ age group) 
Percentage and number of 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.9.  Do  you  think  that vaping  electronic cigarettes  might  encourage people  to start 
smoking/using other tobacco products, or not?  
Source: OE elaboration from online survey data 

In the online survey 80% of the 18-25 age group believed that young people would be particularly 
attracted to e-cigarettes (i.e. both “definitely yes” and “probably yes”), matched by 76% in the 26+ 
age group (see Figure 161 and Figure 162). As with other aspects of e-cigarettes the current users 
and never used held very different opinions. Furthermore, in the focus groups, the range of designs 
and flavours was mentioned as a factors in attracting users of all age groups. Participants reported 
being particularly worried about the growing popularity among the younger generations.  

Figure 161. Perceived appeal of e-cigarettes to youth (18-25 age group)  

Percentage and number of 18-25 age group 

Base: respondents in the 18-25 age group (N=6,090) 
Question:  Question:  Q.4.11.  Do  you  think  that  young  people  might  be  particularly  attracted  to 
electronic cigarettes (vaping), or not? 
Source: OE elaboration from online survey data. 

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Figure 162. Perceived appeal of e-cigarettes to youth (26+ age group)  
Percentage and number of 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question:  Q.4.11.  Do  you  think  that  young  people  might  be  particularly  attracted  to  electronic 
cigarettes (vaping), or not? 
Source: OE elaboration from online survey data 

The concerns about e-cigarette use among young people led on to the view that they underestimate 
the  risks to  health. In the  survey 76%  of the  18-25 age group  and  77%  of the 26+  age  group 
agreed that young people might underestimate the risks of e-cigarette use (see Figure 163 and Figure 
164).  

Figure 163 Extent to which respondents believed that youth underestimate risks of using e-
cigarettes  
Percentage and number of respondents in the 18-25 age group 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.12. Do you think that young people might underestimate the risk of using electronic 
cigarettes (vaping), or not? 
Source: OE elaboration from online survey data 

211 

 
 
 
 
 
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Figure 164 Extent to which respondents believed that youth underestimated risks of using e-
cigarettes 
Percentage and number of 26+ age group 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.12. Do you think that young people might underestimate the risk of using electronic 
cigarettes (vaping), or not? 
Source: OE elaboration from online survey data 

Relative  health  risks  of  tobacco  products.  Figures  151  and  152  show  the  results  of  the  ‘swing 
method’ to assess risk perceptions of the five tobacco and related products included in this study plus 
conventional  cigarettes.  The  swing  method  is  explained  in  1.3.3.  In  brief,  the  respondent  is  asked 
which of the six products they think is most damaging to a user’s health. This product is given 100 
points on a scale from 100 (most harmful) to 0 (not harmful). Then using this scale, the respondent 
is asked to rate each of the other five products on its harmfulness to health of users.  

In the 18-25 age group, conventional cigarettes at a score of 82 are seen as the most harmful to 
health of the six products. E-cigarettes ranked second to lowest in terms of harmfulness to the users’ 
health marginally more harmful than waterpipe tobacco (see Figure 165). Current users perceived e-
cigarette as less harmful than ‘past’ ‘once or twice’ and ‘never users. Current users gave a score of 
40 out of 100 (where 100 represents the most damage to the users’ health) to e-cigarettes, in contrast 
to 60 for ‘never’ users.  

The findings on perceived harmfulness in the 26+ age group are broadly similar to those of the 18-
25 age group (see Figure 166). Conventional cigarettes at 82 were seen as most harmful. E-cigarettes 
at 52 are seen as equally harmful to HTPs and marginally more than waterpipe tobacco.  Current e-
cigarette users of gave a score of 36 compared to 57 for never users. 

212 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 165. Perceived harmfulness of e-cigarettes to users (18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.1.a.126 & Q.3.1.b. You have chosen (e.g.; cigarettes, except slims127) as likely to be the most 
damaging to the health of users. We will give (e.g.; cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g.; cigarettes, except slims), you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. The products are sorted in descending order in 
terms of the score in the “group total,” i.e. amongst all respondents of the age group.  
Source: OE elaboration from online survey data 

126 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
127 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

213 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 166. Perceived harmfulness of e-cigarettes to users (26+ age group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910)  
Question: Q.3.1.a.128 & Q.3.1.b. You have chosen (e.g.; cigarettes, except slims 129) as likely to be the most 
damaging to the health of users. We will give (e.g.; cigarettes, except slims) 100 points on a scale of 0-
100 for damaging users’ health. Please assess the other products’ damage on a scale of 0 to 100. If you 
think a product is about half as damaging to the health of users, you would give that product 50 points. If 
you think another product is just as damaging as (e.g.; cigarettes, except slims), you would give it 100 
points. 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two abovementioned questions. The bars in the graph are the average score of harm to the user provided 
by respondents for products under the scope of this study. The products are sorted in descending order in 
terms of the score in the “group total,” i.e. amongst all respondents of the age group.  
Source: OE elaboration from online survey data 

Passive use of e-cigarettes – harmfulness to others. In terms of harmfulness to passive users, 
electronic cigarettes scored as the least harmful product of the six products for both age groups. E-
cigarette users in the 18-25 age group (Figure 167) gave the lowest rating of 34 compared to 50 
for never users. The results are similar in the 26+ age group (see Figure 168); respondents rated 
e-cigarettes as the least harmful product for others.  Current users gave a score of 30, never users 
45. Furthermore, 13% of current e-cigarette users in 18-25 age group gave the maximum score of 
100 to e-cigarettes in relation to passive use harms. In the 26+ age group, 9% of current users gave 
a maximum score of 100 to e-cigarettes, suggesting that the older cohort of e-cigarette users may 
underestimate the risks associated to e-cigarettes more so than the younger cohort. The focus group 
participants were unclear on whether the emissions of e-cigarettes affected bystanders, but the impact 
on their health was expected to be much smaller than with other products.  

128 Q.3.1.a. Which of the six tobacco products listed below do you think is likely to be most damaging to the health of users? 
129 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

“I've noticed that there were people with e-cigarettes, and nobody said anything, but then 
five meters next to it there were smokers and people were complaining  about them” (M, 
30, DE)  

Figure 167. Perceived harmfulness of e-cigarettes to bystanders(18-25 age group)  

(average score) 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.3.2.a. & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims) as likely to be the 
most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points on 
a  scale  of  0-100  for  damaging  passive  users’  health.  Please  assess  the  other  products’  damage  on  the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims), you would give it 100 points 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two  abovementioned  questions.  The  bars  in  the  graph  are  the  average  score  of  harm  to  passive  users 
provided by respondents for products under the scope of this study. The products are sorted in descending 
order of the score in the “group total,” i.e. all respondents of the age group. 
Source: OE elaboration from online survey data 

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 168. Perceived harmfulness of e-cigarettes to bystanders(26+group)  

(average score) 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.3.2.a.130 & Q.3.2.b. Q.3.2.b. You have chosen (e.g.; cigarettes, except slims 131) as likely to be 
the most damaging to the health of passive users. We will give (e.g.; cigarettes, except slims) 100 points 
on a scale of 0-100 for damaging passive users’ health. Please assess the other products’ damage on the 
health of passive users on a scale of 0 to 100. If you think a product is about half as damaging to the 
health of passive users, you would give it 50 points. But if you think another product is just as damaging 
as (e.g.; cigarettes, except slims), you would give it 100 points 
Note: The graph is based on the swing method. The scores were constructed using the responses to the 
two  abovementioned  questions.  The  bars  in  the  graph  are  the  average  score  of  harm  to  passive  users 
provided by respondents for products under the scope of this study. The products are sorted in descending 
order of the score in the “group total,” i.e. all respondents of the age group. 
Source: OE elaboration from online survey data 

130 Q.3.2.a. Which of the six tobacco products listed below is likely to be the most damaging to the health of other people from 
passive use?  
131 The product in parentheses would change in the online survey based on individual responses to Q.3.1.a.  

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Consumer preference and perception of specific categories of tobacco and related products 

Table 62 and Table 63 shows those settings in which respondents thought that e-cigarette use should 
be  restricted  or  prohibited.  In  both  age  groups  prohibition  at  work,  in  public  transports,  and  in 
restaurants and bars (indoors) is supported by one in two respondents. Furthermore, 15% of the 18-
25 age group and 22% of the 26+ age group wanted prohibition in all of the settings included in 
the questionnaire. 

Table 62 Views on settings where e-cigarettes should be prohibited (18-25 age group) 

 Percentage and number of respondents in the 18-25 age group 

Group 
total 

Use of product 

Restaurants/ bars indoors 

Work 

Public transport 

Open outdoor spaces (e.g. bus stops, 
playgrounds) 

%(n) 
100 
(6090) 
17 
(1032) 
46 
(2789) 
55 
(3342) 
49 
(2966) 
14 
(831) 
26 
(1572) 
15 
(943) 
8 
(513) 
3 
(162) 
Base: respondents in the 18-25 age group (N=6,090) 

Private transportation 

All of the above 

Restaurants/ bars outdoor terraces 

None 

Other 

Current 
users 
% 

Past 
users 
% 

Used 
once or 
twice 
% 

Never 
used 
% 

15 

17 

12 

13 

12 

15 

11 

7 

21 

7 

15 

13 

13 

14 

14 

17 

13 

10 

16 

12 

25 

24 

27 

28 

27 

23 

27 

21 

27 

15 

45 

46 

49 

46 

47 

45 

48 

62 

36 

65 

Question:  Q.4.14.  In  which  settings,  if  any,  do  you  think  that  the  consumption  of  electronic  cigarettes 
(vaping) should be prohibited? 

Note:  Respondents  could  provide  multiple  answers,  except  if  they  selected  “All  the  above”  or  “None”. 
Hence, a special consideration must be made when analysing the responses. Although 17% reported “open 
outdoor spaces”, 32% of respondents in the 18-25 age group were in favour of prohibiting the product 
use in open outdoor spaces (i.e. 17% + 15% that answered “all of the above”). The group total category 
refers  to  the  total  respondents  in  that  age  group.  The  orange  column  represents  the  proportion  of 
respondents in the age group that selected the response option (i.e. 3% of respondents in the 18-25 age 
group responded “other”). The white cells (in the four right columns) represent the breakdown by user 
type, i.e. they are within row percentages (white cells in each row sum to 100). 
Source: OE elaboration from online survey data 

217 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 63 Views on settings where e-cigarettes should be prohibited (26+ age group)  

Percentage and number of respondents in the 26+ age group 

Use of product 

Open outdoor spaces (e.g. bus stops, 
playgrounds) 

Work 

Public transport 

Restaurants/ bars indoors 

Restaurants/ bars outdoor terraces 

Private transportation 

All of the above 

None 

Other 

Group 
total 

%(n) 

100 
(5910) 

17 
(989) 

46 
(2723) 

56 
(3307) 

47 
(2766) 

14 
(826) 

23 
(1377) 

22 
(1291) 

10 
(592) 

1 
(84) 

Current 
users 
% 

Past 
users 
% 

Used 
once or 
twice 
% 

Never 
used 
% 

18 

11 

16 

56 

14 

16 

17 

16 

17 

16 

8 

28 

6 

10 

10 

10 

10 

10 

10 

5 

14 

11 

15 

16 

17 

16 

13 

15 

12 

15 

23 

61 

59 

56 

58 

60 

59 

75 

43 

61 

Base: respondents in the 26+ age group (N=5,910) 

Question:  Q.4.14.  In  which  settings,  if  any,  do  you  think  that  the  consumption  of  electronic  cigarettes 
(vaping) should be prohibited? 

Note:  Respondents  could  provide  multiple  answers,  except  if  they  selected  “All  the  above”  or  “None”. 
Hence, a special consideration must be made when analysing the responses. Although 17% reported “open 
outdoor spaces”, 39% of respondents in the age group were in favour of prohibiting product use in open 
outdoor spaces (i.e. 17% + 22% that answered “all of the above”). The group total category refers to the 
total respondents in that age group. The orange column represents the proportion of respondents in the 
age  group  that  selected  the  response  option  (i.e.  1%  of  respondents  in  the  26+  age  group  responded 
“other”). The white cells (in the four right columns) represent the breakdown by user type, i.e. they are 
within row percentages (white cells in each row sum to 100). 

Source: OE elaboration from online survey data 

In the focus group, it was mentioned that while banning the product could be useful in order to change 
social  norms  and  perception,  campaigns  and  price  changes  of  the  product  were  viewed  as  more 
effective  tools.  Participants  believed  that  when  products  had  no  restrictive-use  regulations  or  were 
tolerated  in  places  where  consuming  conventional  tobacco  was  forbidden  or  frowned  upon  (e.g. 
waterpipe  tobacco  is  allowed  in  bars)  would  indicate  to  users  that  these  are  less  harmful  than 
conventional tobacco.  

“You can smoke that at home (electronic cigarettes) if you don't want to go out to smoke.” 
(M, 28, ES) 

“I think you were no longer allowed to smoke in restaurants, and then the e-cigarettes came 
out as a solution.” (M, 22, DE) 

“In  my  workplace  we  are  allowed  to  smoke  electronic  cigarettes,  while  regular  cigarettes 
are not allowed.” (F, 43, EL) 

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6.4  Health, social and economic impacts 

It has been well-documented that heavy marketing practices were adopted by manufacturers of e-
cigarettes to appeal to  a range  of potential users, including young  people, even under-age,  and to 
promote  the  product  as  a  cessation  aid  (e.g.  Kinnunen,  2015;  Martinez,  2015).  The  systematic 
literature review concluded that specific health risks associated with e-cigarettes were still uncertain 
and  the  long-term  impact  remained  unknown.  (PHE,  2018;  RCP,  2016;  Hua,  2016;  Meo,  2014; 
Callahan-Lyon, 2014; Kim, 2016). The evidence showed that the level of exposure to nicotine from e-
cigarettes is variable, depending on the characteristics of the device and the e-liquid, as well as on 
how the device is operated. Callahan-Lyon (2014) reported that differences in product engineering, 
components and potential toxicities hinder the study of e-cigarettes as a single device. Pisinger (2014) 
outlined some methodological challenges that must be acknowledged in the research on e-cigarette 
health  impacts.  First,  with  research  covering  some  460  brands  that  had  been  subject  to  frequent 
modifications,  it  is  a  challenge  to  arrive  at  valid  generalisations.  Furthermore,  many  studies  have 
compared the health impacts of e-cigarettes with conventional cigarettes, whereas health hazards for 
each  product  may  be  different,  and  also  include  non-smokers.  For  example,  e-cigarette  use 
topography  is  quite  different  to  conventional  smoking  as  the  use  of  e-cigarettes  involves  sucking 
harder with longer puffs. In addition, experimental studies with human participants may not reflect 
real-life use of e-cigarettes. 

Gotts, Jordt, McConnell, and Tarran (2019) provided an extensive assessment of the evidence on the 
pulmonary effects of e-cigarettes, covering the population, clinical, animal, and cellular evidence. The 
research  found  that  studies  funded  by  the  tobacco  industry,  unlike  non-tobacco  industry  funded 
literature,  did  not  find  lung  problems  with  e-cigarettes.  More  recently,  in  the  USA,  a  lung  ailment 
reportedly killed at least 68 people and afflicted nearly 2,807 patients, as of February 2020 (Center 
for  Disease  Control  and  Prevention).132  While  this  disease  highlighted  the  need  for  further 
investigations on the product and its composition, differences in the regulatory arrangement of the 
US and the EU, protected EU citizens from the risk.133 Specifically, the outbreak of illness was linked 
to the refill capsules, and laboratory studies identified vitamin E acetate, an additive in some THC-
containing  e-cigarette  or  related  products,  as  strongly  linked  to  what  has  been  coined  the  EVALI 
outbreak.134 The TPD, which has been applicable in the EU Member States since May 2016, regulates 
the  sale  and  merchandising  of  e-cigarettes  in  the  EU.  The  TPD  (2014/40/EU)  does  not  permit  the 
addition of types of vitamins. The Directive also requires e-cigarette manufacturers to notify Member 
States of all products placed on the market and to report annually on sales volumes. 

Many recent studies have argued for the need to better codify and understand the health impacts of 
e-cigarettes in order to have evidence-based policies for tobacco control (PHE, 2018; RCP, 2016; Hua, 
2016;  Kim,  2016).  Levy  (2017)  proposed  a  framework  describing  and  incorporating  patterns  of 
vaporised nicotine products (VNPs, such as e-cigarettes and HTPs) to determine the total amount of 
toxic exposure effects on a population health. While the framework identified some critical information, 
it is expected that there will be further product innovations and changes in patterns of use such that 
health risks may change as well. Kalkhoran (2015, UK & USA) developed a model to evaluate potential 
health  effects  of  increasing  promotion  and  use  of  e-cigarettes.  The  outcome,  supported  by  results 

132 "Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping". Centers for Disease Control and Prevention. 28 January 
2020.  This  article 
the  public  domain.  Available  at: 
this  source,  which 
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html  
133 There have been suspected cases (e.g. Belgium) but the underlying cause has not yet been clarified.  
https://www.europarl.europa.eu/doceo/document/P-9-2019-003949-ASW_EN.html 
134 https://www.bloomberg.com/news/articles/2019-09-13/europe-says-thank-you-for-vaping-as-u-s-tells-consumers-to-stop  

incorporates 

from 

text 

in 

is 

219 

 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

from Polosa (2013)135 was that greater e-cigarette use could have different health effects for different 
population segments.  

What  have  the  survey  findings  contributed  to  the  debate  on  whether  e-cigarettes  were  an  aid  to 
quitting conventional cigarettes (the cessation scenario) or whether young people would take up the 
use of e-cigarettes and progress to conventional cigarettes (the gateway scenario). Before looking at 
the survey evidence a note of caution is needed. The online survey was a cross-sectional study and, 
as such, cannot lead to causal claims. 

Just below 1 in 5 in both age groups said they had previously used other products but were now only 
using e-cigarettes. 1 in 12 of the younger age group and 1 in 25 of the older age group were exclusive 
e-cigarette users and had not used other products. Given that ‘cutting down or quitting other tobacco 
products’  was  cited  as  a  reason  for  taking  up  e-cigarettes,  these  findings  were  suggestive  of  the 
cessation scenario. However, over 7 in 10 of the 18-25 age group and 8 in 10 of 26+ age group were 
dual users of e-cigarettes and other products, mainly conventional cigarettes.  

Of past e-cigarette users, 1 in 4 in both age groups had been dual users and now were not using any 
tobacco and related products. This is suggestive of the cessation scenario. Suggestive of the gateway 
scenario,  1  in  4  of  the  18-25  age  group  and  3  in  10  of  the  26+  age  group  had  been  exclusive  e-
cigarette users and now reported using other tobacco and related products, with some 90% reporting 
the  use  of  conventional  cigarettes.  Marginally  more  than  4  in  10  of  both  age  groups  were  past  e-
cigarette users and reported current dual use of other tobacco and related products. The use of e-
cigarettes had not made an impact on their use of tobacco.  

Overall,  the  survey  findings  are  suggestive  of  both  cessation  and  gateway  scenarios.  This  in  the 
context  of  dual  use  reported  by  a  substantial  majority  of  the  current  e-cigarette  users  and  by 
significant numbers of past e-cigarette users. 

Finally,  in  terms  of  policy,  some  Member  States  have  taken  additional  measures  to  regulate  the 
consumption  of  e-cigarettes.  In  Germany,  the  DKFZ  (2018b)  have  in  the  past  advised  schools  to 
extend smoking bans to all e-products via the house right, as there were no legal regulations regarding 
e-cigarettes and e-hookahs in place at that time. This recommendation was justified on the basis that 
schools are a place of living and learning and that they should be a protected space in which legal and 
illegal drugs have no place. An ongoing study by Kimber (2018-19, EU) compares the effects of the 
EU TPD, e-cigarette health warnings and a comparative harm message (developed specifically for that 
study) on smokers’ and non-smokers’ perceptions of harm, addictiveness and social acceptability of 
e-cigarettes.  Additionally,  the  potential  effects  of  the  TPD  warnings  and  the  impact  on  tobacco 
consumers’ purchase and use intentions regarding e-cigarettes are being explored (Kimber, 2018-19, 
EU). Health warnings, such as those implemented by the TPD, may help to prevent non-smokers from 
e-cigarette  use,  but  it  is  also  possible  that  they  may  inadvertently  deter  tobacco  consumers  from 
switching from conventional tobacco products to e-cigarettes.  

135 Disclaimer: the paper was supported by the electronic cigarettes industry. 

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6.5  Concluding remarks on electronic cigarettes 

The main findings on e-cigarettes emerging from the literature review and empirical work conducted 
under the present study are summarised below. The systematic review of secondary sources revealed: 

  E-cigarettes are a heterogeneous class of products that use an electrically powered coil to heat 

and turn a liquid into an aerosol, which is inhaled by the user.  

  E-cigarettes  are  not  harmless.  Dual  use  of  electronic  cigarettes  with  cigarettes  and  other 
tobacco  products  does  not  provide  any  significant  reduction  in  exposure  to  tobacco-related 
toxicants compared to those smoking conventional cigarettes. 

  While  there  is  limited  evidence  that  e-cigarettes  may  be  effective  aids  to  promote  smoking 
cessation, there is moderate evidence from observational studies that more frequent use of e-
cigarettes  is  associated  with  an  increased  likelihood  of  cessation  among  older  smokers. 
However,  e-cigarettes  may  act  as  a  gateway  product  encouraging  youth  who  use  them  to 
transition  to  use  of  conventional  cigarettes  or  develop  lasting  habits  through  addiction  to 
nicotine.  

  The prevalence of current e-cigarette use in the EU is 2% among adults (15+). According to 
Passport data, electronic cigarette sales were 4.2 billion euros. The leading markets were UK 
and Italy.  

The empirical work (focus groups and online survey) revealed the following user profile: 

  A typical current e-cigarette user has between 1 and 10 sessions a day, started as a minor or 
young adult, and started either for enjoyment (in the 18-25 group) or to try to quit or reduce 
smoking of conventional tobacco products (in the 26+ group).  In the 18-25 age group 38% 
started using e-cigarettes for ‘enjoyment’ and 33% were ‘trying to quit or reduce consumption 
of another tobacco product’. The 26+ age group cited the same reasons. But 54% cited ‘trying 
to quit or reduce consumption of another tobacco product and 28% said for ‘enjoyment’.  

  About three in four current e-cigarette users were dual users of other tobacco products. 53% 
of the 18-25 age groups had never attempted to quit. Of those who had tried 54% did so on 
account of ‘personal health’, ‘health warning labels’ or ‘concern for bystanders’ health’. 63% of 
the  26+  age  group  had  never  attempted  to  quit  and  of  those  who  had  tried  51%  cited  the 
same reasons as the younger group. 

  The UK and Italy had the largest current consumption of e-cigarettes. Respondents in the 18-
25 age group reported experimenting with the product (i.e. ‘used once or twice’) more often 
than  respondents  in  the  26+  age  group.  The  18-25  age  group  reported  using  the  product 
mainly for ‘enjoyment’.  

  Current users were evenly split between those that had never attempted quitting the use of e-
cigarettes and those who tried at least once and failed in the 18-25 group. In the 26+ group, 
almost two in three had never tried to quit. Among failed quitters, the main reason to try was 
for personal health. Other reasons frequently mentioned were economic reasons and not liking 
it  anymore.  The  main  reason  cited  for  failing  to  quit  was  being  stressed.  Other  important 
reasons  mentioned  were  that  they  found  quitting  electronic  cigarettes  difficult  and  that 
electronic cigarettes were not that harmful compared to other products anyway.  

 

In the 18-25 age group, 74% of current e-cigarette users were dual user of tobacco and/or 
other  tobacco  related  products:  82%  reported  using  conventional  cigarettes.  18%  indicated 
that they had previously used other products but were now only using e-cigarettes. 8% had 
only ever used e-cigarettes. The same pattern was found for the 26+ age group. 78% were 

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Consumer preference and perception of specific categories of tobacco and related products 

dual  users  and  90%  of  these  reported  using  conventional  cigarettes.  18%  had  used  other 
products and were now only using e-cigarettes and 4% were exclusive e-cigarette users.  

  Evidence  for  a  strong  positive  relationship  between  use  of  e-cigarettes  and  later  cigarette 
consumption amongst youth has continued to accumulate in observational studies. The present 
research has findings that support both the cessation and gateway scenarios. 

  Suggestive of the cessation scenario in both age groups 18% reported using other tobacco and 
related  products  in  the  past  and  now  only  using  e-cigarettes.  Furthermore,  of  current  e-
cigarette users 8% of the 18-25 age group and 4% of the 26+ age group reported never using 
other products. However, that 74% of the 18-25 age group were dual users and 82% reported 
using conventional cigarettes chimes with the gateway scenario. 

  Also suggestive of the gateway scenario, 23% of the 18-25 age group and 31% of the 26+ age 
group  were  exclusive  e-cigarette  users  and  now  reported  using  other  tobacco  and  related 
products, with some 90% reporting the use of conventional cigarettes.  

  Concerning the past users of e-cigarettes, 7% of the 18-25 age group and 2% of the 26+ age 
group were never users of other tobacco and related  products. 24% of the 18-25 age group 
and 23% of the 26+ age group were dual users in the past and now were not using any tobacco 
and related products – suggestive of the cessation scenario.  

  These quantitative findings on dual use were illustrated in the focus group discussions. People 
said  that  the  main  purpose  for  using  e-cigarettes  was  to  quit  conventional  cigarettes;  to 
alternate e-cigarettes with conventional tobacco products in order to reduce consumption of 
the  latter;  to  use  the  e-cigarette  in  places  where  smoking  was  not  allowed  but  e-cigarettes 
were tolerated (at some work places, bars, malls, etc. , also depending on the country); or, to 
use in places where smoking is not forbidden, but it was preferable not to smoke in order to 
avoid  harming  others  (e.g.  at  home)  –  the  latter  was  particularly  relevant  for  those  with 
children.  

  The  perception  of  e-cigarettes  was  varied  in  terms  of  general  awareness,  but  especially  in 
terms of the awareness of some danger to the health of the user. The literature revealed similar 
misperceptions and confusion, and further explained that evidence on the health impacts was 
still inconclusive and at times even controversial.  

Lastly, the following paragraphs highlight the Product and Regulatory perceptions remarks 

  While the overall sample viewed e-cigarettes in a more negative than a positive light, this view 
varied according to the level of use of the product. Current users of the product were much 
more likely to view the product in a favourable light than never users. E-cigarettes are seen as 
unhealthy, addictive and modern/technological.  Users  of e-cigarettes  considered them more 
socially  acceptable  than  smoking  because  they  consider  that  it  does  not  produce  “smoke”, 
smell bad, or a nuisance to others.  

  A majority of e-cigarette users and ‘never users’ raised concern about the possibility that use 
of e-cigarettes might appeal to youth and encourage them to start smoking/using other tobacco 
and related products. The survey data revealed that the younger generations were of particular 
target group for the product and a large majority of respondents believed that youth may be 
particularly attracted to using the product.  

  The range of designs and flavours were mentioned as key factors in attracting users of all age 
groups  and  particularly  the  younger  generations.  Flavour  and  trends  could  be  important 
influences as well as the marketing practices, notably on social media (e.g. Instagram). The 
findings were consistent with the literature. 

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  Perception  of  marketing  practices.  Participants  in  the  focus  groups  argued  that  marketing 
techniques  had  exploited  the  flavours  and  design  features  of  the  product  to  target  young 
people.  

  There  was  support  for  regulations  to  prohibit  the  use  of  e-cigarettes  in  at  work,  in  public 
transport and in restaurants and bars. Passive exposure of e-cigarettes was viewed as the least 
harmful of the tobacco products in this study.  

  The marketing practices of the new tobacco products should be closely monitored as the overall 
perception of e-cigarettes appeared to be marked by social factors; tobacco advertising claims 
were also cited quite frequently in the online survey. The literature indicated that youth was 
more likely to be influenced by the marketing practices and design, which have established the 
device as both a trend and as a smoking cessation aid.  

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7  Comparative analysis of tobacco and related products 

In  this  chapter,  we  describe  the  average  profiles  of  users  of  the  five  tobacco  and  related  products 
within  the  scope  of  this  study  with  occasional  reference  to  users  of  conventional  cigarettes, 
highlighting  potential  similarities  and  differences  in  terms  of  age,  gender,  education  level, 
socioeconomic status and regional distribution. We also explore and compare the patterns of use, the 
perception and the impacts of the five tobacco and related products.  

7.1  Market developments 

The last decade has seen an overall decrease in smoking prevalence. Tobacco products have been the 
focus  of  tightening  regulations  for  decades  across  the  EU  region  to  ensure  consumer  protection  as 
well as smooth functioning of the internal market. Measures include higher taxation and increasing 
health awareness across society, through for example the establishment of mandatory health warnings 
on packaging. However, concurrently, the tobacco industry has developed new alternative products 
in order to maintain its customer base as well as attract new consumers.  There has been a general 
decrease in the use of  tobacco products in the EU between 2012 and  2017. As displayed in  Figure 
169, the share of smokers decreased in 20 of the 28 EU countries between 2012 and 2017, while it 
either increased or remained the same in 7 countries.136  

Figure 169 Share of smokers by countries 

Source: Eurobarometer (2012, 2015, 2017) 

The figure below summarises the market  share of  specific tobacco  and related products across the 
different national markets according to Passport data in 2017.137 Western EU countries reported larger 
markets for e-cigarettes and waterpipe tobacco products. The UK (77%), Poland (4.2%) and Denmark 
(4.2%)  had  the  highest  share  of  electronic  cigarettes  in  the  tobacco  and  related  products’  market. 
Waterpipe  tobacco  had  high  shares  of  the  market  in  Denmark  (2%)  and  Germany  (1.4%).  In 
comparison, small cigarillos and slim cigarettes tend to have larger markets in eastern Member States. 
Small  cigarillos  were  more  prevalent  in  Finland  (5%),  Lithuania  (4%),  and  Latvia  (2.4%).  Slim 
cigarettes138  were  most  widely  used  in  Bulgaria  (37.4%),  Poland  (32%),  Lithuania  (22.3%),  Latvia 

136 Note that Croatia does not have available data prior to 2017 and therefore a trend cannot be implied. 
137 It is important to note that the data for the waterpipe market are aggregated at a higher level including both waterpipe and 
pipe tobacco. Acknowledging this, for simplicity, we will refer to waterpipe market data 
138 Slim and superslim cigarettes are combined in this section.  

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Consumer preference and perception of specific categories of tobacco and related products 

(21.3%) and Greece (14%). Among the countries for which data was available, the highest share of 
HTP was found in Romania (2.2%) and Slovakia (1.4%).  

Table 64. Market size share of selected tobacco and related products by countries 

Percentage of total tobacco market in the country in 2017139 

Small 
cigarillos 

Waterpipe 

Electronic 
cigarettes 

HTP 

Slim 
cigarettes 

AT 

BE 

BG 

CY 

CZ 

DE 

DK 

EE 

EL 

ES 

FI 

FR 

HR 

HU 

IE 

IT 

LT 

LU 

LV 

MT 

NL 

PL 

PT 

RO 

SE 

SK 

SL 

UK 

1.1 

1.4 

0.2 

- 

0.2 

2.5 

0.9 

1.4 

0.6 

2.1 

5.1 

2.6 

0.5 

2.3 

0.2 

0.6 

3.0 

- 

2.5 

- 

1.3 

0.1 

2.1 

0.1 

0.8 

0.3 

1.9 

0.7 

0.1 

0.1 

0.1 

- 

0.3 

1.4 

1.9 

0.4 

0.0 

0.5 

0.2 

0.3 

0.1 

0.2 

0.2 

0.2 

0.4 

- 

0.5 

- 

0.3 

0.3 

0.2 

0.1 

0.2 

0.0 

0.3 

0.4 

0.7 

1.7 

1.2 

- 

1.5 

2.0 

4.2 

2.2 

2.5 

0.7 

0.3 

2.2 

1.8 

0.5 

3.9 

3.0 

1.4 

- 

1.5 

- 

1.8 

4.2 

0.9 

2.7 

2.1 

2.3 

2.3 

7.0 

- 

- 

- 

- 

0.1 

0.0 

0.3 

- 

0.8 

0.2 

- 

0.0 

- 

- 

- 

0.6 

0.4 

- 

0.2 

- 

0.1 

0.2 

0.8 

2.2 

- 

1.4 

0.2 

0.0 

2.6 

0.1 

37.4 

- 

8.1 

1.3 

3.0 

9.3 

14.0 

0.1 

0.1 

2.9 

7.0 

12.6 

0.7 

6.9 

22.3 

- 

21.3 

- 

1.4 

32.0 

3.6 

13.1 

4.8 

6.0 

5.9 

0.8 

EU 
Note: EU average is calculated for 25 EU members (excluding Cyprus, Luxembourg and Malta) 
Source: Passport, 2017 

0.1 

0.7 

1.1 

2.6 

- 

139 Note: Data on heated tobacco products is not available for Austria, Croatia, Czech Republic, Hungary, Ireland, Latvia, Poland, 
Slovakia, Sweden. Share of slim cigarettes is available only for retail volume in million sticks, in order to make a comparable 
graph  we  used  it  as  a  share  of  the  retail  volume  RSP  for  cigarettes  in  general.  Slim  cigarettes  include  slim  and  super  slim 
cigarettes classification. 

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The comparative findings from the online survey are presented in in the figures below. In the 18-25 
age group, 32% were current users of cigarettes, 15% of e-cigarettes, 11% of waterpipe, 11% of 
slim cigarettes, 8% of HTPs and 6% of small cigarillos. Although current users of HTPs had a marginally 
higher share than small cigarillo users, 69% of respondents had never used HTPs compared to 65% 
of respondents for small cigarillos. While HTPs were a relatively new product, there were 8% of current 
users  in  the  18-25  age  group.  This  suggests  that  the  market  is  growing  and  can  be  expected  to 
continue growing. 

Figure 170. Overview of the consumption of the five products (18-25 age group) 

Base: all respondents in the 18-25 age group (N=6,090) 
Question: Q.1.1. Have you ever used the following products? 
Note: The group total category refers to all respondents within the age group. Note that there is a 
positive sampling bias so these numbers may appear higher than they would in a representative 
sample. 
Source: OE elaboration from online survey data 

For  the  26+  age  group  (see  Figure  171),  there  were  higher  levels  of  current  consumption  for 
electronic cigarettes (18%), followed by slim cigarettes (12%) and HTPs (11%) across the EU markets 
under  study.  The  share  of  HTP  current  users  appeared  particularly  high  given  the  novelty  of  the 
product.  

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Figure 171. Overview of the consumption of the five products (26+ age group) 

Base: all respondents in the 26+ age group (N=5,910) 
Question: Q.1.1. Have you ever used the following products? 
Note: The group total category refers to all respondents within the age group. Note that there is a 
positive sampling bias so these numbers may appear higher than they would in a representative 
sample. 
Source: OE elaboration from online survey data 

The sample of the online survey did not reveal significant differences in education levels across the 
products users for the 18-25 age group, except for small cigarillos (see Figure 200. in Annex). One in 
ten small cigarillo users (10%) had a low education level, compared to 6% in the total age group. For 
respondents in the 26+ age group (see Figure 201. in Annex), users of HTPs and waterpipe tobacco 
appeared  to  have  a  relatively  higher  level  of  education  -  with  64%  and  62%  respectively  -  when 
compared to the overall sample (49%).  

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Figure 172 and Figure 173 report gender differences in the use of the tobacco and related products 
for the two age groups. The large majority of small cigarillo users were male (70%) in the 18-25 age 
group. The same trend was observed in the 26+ age group with 68% of small cigarillo users being 
males. Furthermore, 58% of slim cigarette users were females and 62% of waterpipe tobacco users 
were male. The gender division were much more balanced for these products and others amongst the 
18-25 age group.  

Figure 172. Gender of consumers by product: 18+25 age group 

Base: all respondents in the 18-25 age group (N=6,090) & respondents that were current users for each product 
(see numbers in parentheses) 
Note:  The  group  total  category  refers  to  all  respondents  within  the  age  group.  Note  that  there  is  a  positive 
sampling bias so these numbers may appear higher than they would in a representative sample.  
Source: OE elaboration from online survey data 

Figure 173. Gender of consumers by product: 26+ age group 

Base: all respondents in the 26+ age group (N=5,910) & respondents that were current users for each product 
(see numbers in parentheses) 
Note:  The  group  total  category  refers  to  all  respondents  within  the  age  group.  Note  that  there  is  a  positive 
sampling bias so these numbers may appear higher than they would in a representative sample. 
Source: OE elaboration from online survey data 

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On self-reported economic status, users of small cigarillos in the 18-25 age group reported belonging 
to a high socio-economic class more often than no users of this product. This trend was also observed 
to  a  lesser  degree  for  HTPs,  electronic  cigarettes  and  waterpipe  tobacco.  In  the  26+  age  group, 
waterpipe users were more likely to self-report a higher socio-economic status as did users of small 
cigarillos and HTPs.  In  both age groups users  of  HTPs,  slim  cigarettes and waterpipe tobacco were 
more likely to come from urban areas. (see section 10.6). 

Over three quarters of current users of HTPs, slim cigarettes and small cigarillos were dual users of 
other  tobacco  and  related  products.  The  great  majority  reported  smoking  conventional  cigarettes. 
While HTPs and e-cigarettes have been marketed as an aid to quitting conventional tobacco products 
the  percentages  of  the  current  users  of  HTPs  and  e-cigarettes  who  are  (i)  using  no  other  tobacco 
products and (ii) are dual smokers are shown in the following table: 

Table 65. Career flows of use for current users of HTPs and e-cigarettes (18-25 & 26+ age groups) 

Percentage of current users in the 18-25 & 26+ age groups  

Research questions 

HTPs (%) 

e-cigarettes (%) 

Exclusive users of either product 

18-25 age group 

26+ age group 

16% 

14% 

Users of either e-cigarettes or HTPs and parallel users (dual users) 

18-25 age group 

26+ age group 

84% 

86% 

26% 

22% 

74% 

78% 

Base: current users of HTPs in the 18-25 age group (N=503); current users of HTPs in the 
26+  age  group  (N=634);  current  users  of  e-cigarettes  in  the  18-25  age  group  (N=919); 
current users of electronic cigarettes in the 26+ age group (N=1,051). This includes dual use 
with any tobacco and related product 
Question: Q.1.1. Have you ever used HTPs?; Q.1.1. Have you ever used e-cigarettes? 
Source: OE elaboration from online survey data 

Among the users of either HTPs or e-cigarettes who are using no other tobacco products, more than 
three quarters were past users of other products. The percentage is particularly high in the case of 
HTPs, almost 90%. In the case of e-cigarettes 32% of people in the 18-25 age group never used other 
products. The percentage declines to 18% for the 26+ age group as summarised in Table 66 

Table 66. History of current exclusive users of HTPs and e-cigarettes (18-25 & 26+ age groups) 

Percentage of current users in the 18-25 & 26+ age groups  

Research questions 

HTPs (%) 

e-cigarettes (%) 

Never users of other products 

18-25 age group 

26+ age group 

Exclusive current user & past user of other product(s)  

18-25 age group 

26+ age group 

6% 

8% 

94% 

92% 

32% 

18% 

68% 

82% 

Base: current users of HTPs in the 18-25 age group (N=503); current users of HTPs in the 26+ 
age group (N=634); current users of e-cigarettes in the 18-25 age group (N=919); current users 
of electronic cigarettes in the 26+ age group (N=1,051)  
Question: Q.1.1. Have you ever used HTPs?; Q.1.1. Have you ever used e-cigarettes? 
Source: OE elaboration from online survey data 

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7.2  Consumer perception 

The survey elicited a wide range of perceptions on the five tobacco and related products, with some 
emerging  trends.  Respondents  who  had  tried  or  used  the  products  had  typically  done  so  for 
enjoyment. Specifically, the two main reasons cited for using waterpipe tobacco, slim cigarettes and 
small cigarillos were ‘for enjoyment’ followed by ‘to socialise / it was trendy’ consistently across both 
age  groups  and  user  types  (current  users,  past  users  and  tried  the  product  once  or  twice). 
Furthermore,  the  range  of  flavours  was  part  of  the  appeal  of  waterpipe  tobacco,  as  it  was  for  e-
cigarettes and small cigarillos. Flavours make the smoke more palatable and lead some to think that 
use is less harmful. 

Small cigarillos were used by marginally over 5% in both age groups and mainly by males. The survey 
identified higher than average consumption in Poland which had relatively lower prices for the product 
compared  to  the  EU  average.  The  distribution  of  prices  for  small  cigarillos  in  2017  showed  some 
significant variation across the Member States, an issue that is worthy of monitoring.  

HTPs  and  e-cigarette  users  had  somewhat  different  profiles.  In  the  18-25  age  group,  for  33%  the 
dominant reason for using either e-cigarettes or HTPs was ‘enjoyment’. Other reasons included trying 
to quit and ‘to socialise / it was trendy’. While HTPs and e-cigarettes were promoted and are viewed 
as cessation tools, the main driver for the younger respondents were trends and the social aspect.  

By contrast, for the 26+ age group the main reason for using these products was ‘to try to quit or to 
reduce consumption of another tobacco product’. This pattern was particularly pronounced among e-
cigarette users with 47% reporting this as their main reason for using the product. 41% of HTP users 
also stated ‘concern for their health’ as their main reason for using the product closely followed by ‘for 
enjoyment’ (34%).  

Respondents in the online survey were asked where they had heard about HTPs first, if they knew the 
product prior to the survey. A logit regression was performed to determine if respondents were more 
likely to become users after hearing about HTPs through a particular information channel. There was 
a positive correlation between being a user of HTPs and having heard about HTPs for the first time 
through Facebook, Instagram or other social networks.  

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Table 67. Influence of channels of information on use 

Predictors 

User (1)  

Estimates 

CI 

Facebook, Instagram or other social media networks   0.67 *  1.11 – 3.67 

Other online advertisement 

0.48 

0.92 – 3.09 

Traditional media (print, TV, radio, billboards) 

0.39 

0.83 – 2.81 

Marketing in shops or tobacco stores 

0.44 

0.89 – 2.89 

Observed in the street 

Friends and family 

0.22 

0.71 – 2.35 

0.25 

0.75 – 2.38 

Product promotions in stores, stations or airports etc. 

0.49 

0.93– 3.07 

Control variables  

Yes 

- 

(Intercept) 

Observations 

R2 Tjur 

-0.99 *  0.17 – 0.78 

7945 

0.060 

Base: respondents of the online survey that had heard of HTPs prior to the survey (N=7,945) 
Note: *** refers to the 0.01 level, ** refers to the 0.05 level & * refers to the 0.1 level, the latter not 
being considered as significant for the purpose of this study.  
 User is a dummy variable where users have a value of 1 and non-users a value of 0. 
Source: OE elaboration from online survey data 

A  study  commissioned  by  the  EC  (2015)  found  that  there  was  no  evidence  of  paid  advertising  for 
tobacco on the internet prior to the TPD. However, the focus group participants mentioned, and the 
survey charted, some evidence of commercial practices that could be interpreted as promoting tobacco 
products. These included prize draws, news items about tobacco retailing, and product promotions in 
stores  and  airports.  User-generated  content  promoting  specific  tobacco  brands  and  products  was 
reported to have been seen on Facebook. Given that younger people are frequent users of the social 
media they may be exposed to tobacco-related content whether genuine advertising or not.  

Despite the fact that most respondents  claimed their decision to smoke  e-cigarettes and HTPs was 
based on health reasons, the majority of respondents across EU countries were aware that there were 
potentially  harmful  health  effects  linked  to  product  use  –  as  consistent  with  findings  from  the 
Eurobarometer 458. However, users of products systematically ranked their preferred product as less 
harmful  than  did  past  users,  those  who  had  tried  the  product  once  or  twice  and  never  users.  Use 
creates a tendency to deny the risks. Users of waterpipe tobacco perceived it as less harmful than all 
the other products, while the evidence has shown that waterpipe tobacco use can be more toxic than 
conventional cigarettes. 

Although  nicotine  was  widely  identified  as  the  key  chemical  compound  that  causes  and  sustains 
addiction to tobacco and related products, other indicators have been found to also affect dependence. 
A study analysing the indicators of dependence on e-cigarettes, waterpipe and small cigarillos reported 
that appeal, ease of use, use frequency and the manner in which nicotine is delivered were factors 
that  influenced  their  use  (Strong,  2017,  USA,  N=14.287).  Furthermore,  dual  use  of  tobacco  and 
related products was found to be a driver of higher tobacco dependence and of higher use of tobacco 
and  related  products.  For  waterpipe  tobacco  in  particular,  the  present  study  found  that  consumers 
largely associated it with a socialising ritual and that it was not necessarily considered “smoking” in 

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Consumer preference and perception of specific categories of tobacco and related products 

the  traditional  sense  and  dissociated  from  conventional  tobacco  products.  Small  cigarillos  were 
associated with special days and family events and slim cigarettes carried connotations of femininity, 
elegance and sophistication. 

As illustrated in the tobacco and related product chapters, both age groups systematically perceived 
the five products in this study as less harmful than conventional cigarettes. The 18-25 age group gave 
higher scores of harmfulness for all the products than did the 26+ age group. The same held for the 
perception of the harmfulness to bystanders. Respondents in the online survey were asked to select 
which of the six products that they considered most harmful to the health of users. They were asked 
to give that product a score of 100 on a harmfulness scale from 100 (most harmful) to 0 (not harmful 
at  all).  They  then  scored  each  of  the  other  tobacco  products  on  the  scale.  In  the  table  below  two 
average scores for the two age groups are presented, one for all respondents in each age group and 
the  other  for  current  users  of  the  product.  The  scores  show  that  (i)  the  products  divide  into  three 
categories,  (ii)  while  users  of  a  particular  product  assess  the  health  risk  to  be  lower  than  the  age 
groups as a whole, they are still rating the products as harmful to health and (iii) the older age group 
report  lower  risk  perception  than  the  younger  age  group.  Conventional  cigarettes  are  the  most 
harmful, followed by small cigarillos and slim cigarettes rated about 20% less harmful, and in the third 
category e-cigarettes, HTPs and waterpipe tobacco approximately another 15% less harmful. While 
there have been  claims that e-cigarettes are 95% less harmful than conventional cigarettes,  those 
surveyed in this study report much high health risk perception. A related and significant finding is the 
perception of risk of passive smoking. For e-cigarettes, for example, the harm to others scored only 
about 10 points lower than the perceived risk to users. 

Table 68. Relative risk perception of the products 

Cigarettes 

Small  
cigarillos 

Slim 
cigarettes 

E-cigarettes 

HTPs 

Waterpipe 

Age 

All 

Users  All 

Users  All 

Users  All 

Users  All 

Users  All 

Users 

18-25   82 

26+  

82 

75 

73 

67 

61 

62 

52 

66 

60 

61 

52 

55 

52 

48 

45 

58 

51 

52 

44 

53 

47 

45 

41 

Source: Own elaboration 

A logistic regression was performed to see how the perception of harm to passive users was related 
to the level  of agreement with the proposal that e-cigarettes and  HTPs  should fall under  the  same 
regulations as conventional cigarettes (see Table 91 in the annex). Perception of harmfulness to others 
is not correlated with the support for regulation, as confirmed by the findings presented in the previous 
chapters. Only being a user of the product impacted the desire to regulate for e-cigarettes. In other 
words, a user of e-cigarettes was less likely to support the idea that the product should be regulated 
like conventional cigarettes 

7.3  Health, social and economic impacts  

Tobacco consumption has negative health, social and economic impact not only at the individual level 
but also on society as a whole. Smoking and other forms of tobacco use remain one of the largest 
avoidable causes of morbidity and premature death in the EU. The negative health impacts of tobacco 
use are well established, and smoking has been linked to several forms of cancer, respiratory diseases, 
vascular diseases, negative reproductive effects and a wide range of other negative health impacts 
such as increased  risks of cataracts and adverse  surgical outcomes  related to poor  wound healing. 
Tobacco-related  diseases  incur  considerable  direct  and  indirect  costs  for  society,  including  direct 
healthcare  costs  and  indirect  costs  such  as  productivity  losses  (absenteeism,  lost  skills, 
unemployment),  welfare  provision  costs  (sickness  and  unemployment  benefits)  and  fire  and  other 

232 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

accidents (property losses, wild fires), as well as intangible costs such as pain and suffering that result 
from loss of life or illnesses brought on by tobacco use. 

Devices for novel tobacco products (and so HTPs) are not explicitly stated in the TPD, except for e-
cigarettes (liquids and devices). Emissions of e-cigarettes and HTPs are however an interplay of the 
device, the sticks, and/or the liquids. 

The economic costs of tobacco use are substantial and include significant healthcare costs for treating 
tobacco-related  diseases  as  well  as  the  loss  of  human  capital  due  to  morbidity  and  mortality 
attributable  to  tobacco  use.  It  has  been  suggested  that  about  15%  of  the  aggregate  health  care 
expenditure in high-income countries can be attributed to smoking (Epku & Brown, 2015). Smoking 
also poses considerable indirect costs to society  through passive smoking, it can cost employers in 
the  form  of  loss  of  productivity  and  absenteeism  of  smokers  due  to  illnesses,  it  pollutes  the 
environment, and more (Epku & Brown, 2015). In terms of economic impact, the main source of data 
was  Passport  data  on  taxes.  Significant  increases  in  the  taxes  and  prices  of  tobacco  and  related 
products is a strong measure to reduce their use. There are certain disparities in taxation levels of 
tobacco  and  related  products  across  countries  and  within  different  product  types.  The  first  figure 
represents the geographical scope of VAT in the year 2017 applied to all tobacco products. The highest 
VAT was applied in Hungary, Denmark and Sweden.  

Figure 174. VAT values on tobacco products by countries in 2017 

Note: Percentage share of slim cigarettes were estimated with respect to the whole tobacco market in the 
country in million euros. 
Source: Passport 

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Consumer preference and perception of specific categories of tobacco and related products 

In terms of excise duty applied to manufactured tobacco, tax rates differed across Member States and 
across specific product categories. In 2011, the Council adopted the Directive 2011/64 on the structure 
and rates of excise duty applied to manufactured tobacco (also known as ‘Tobacco Excise Directive’ – 
TED),  which  updated  the  harmonised  rules  for  the  structure  and  rates  of  excise  duty  applied  to 
manufactured  tobacco  products  on  tobacco  products  in  the  EU.  Following  the  directive,  the  tax 
provisions applicable to manufactured tobacco should follow the structure for each main category. The 
products within scope of this study fall under the 4 main category defined by the Directive 2011/64 . 
The rates or amount defined in this Directive shall be effective for all products belonging to the group 
without distinction within each group. 

Table 69. Tax provisions applicable to manufactured tobacco 

Product 

Tax structure 

Cigarettes (including 
slim cigarettes) 

Cigars and cigarillos 
(including small 
cigarillos) 

Other Smoking 
Tobacco category 
(including 
waterpipe) 

  Mandatory mixed structure including both an ad valorem excise duty and 
a specific excise duty, which must be b/w 7.5% and 76.5% of total tax 
burden (since Jan. 2014). 

  At least 60% of WAP and no less than EUR 90 per 1,000 cigarettes; or 

EUR 115 per 1,000 cigarettes. 

  A minimum excise duty (MED) may apply (i.e. a fixed monetary amount 
per  quantity  applicable  if  the  amount  of  the  excise  duty  falls  below  a 
minimum floor). 

  5% or more of the retail selling price or EUR 12 per 1,000 items or Kg. 
  A minimum amount of excise duty can be established 

  20% or more of the retail selling price or EUR 22 per Kg. 
  A minimum amount of excise duty can be established. 

Source: Own elaboration 

Due to their novelty, the categorisation of HTPs under the Directive was not clear and various Member 
States  adopted  ad-hoc  and  special  tax  regimes.  Similarly,  e-cigarettes  were  not  included  in  the 
Directive and some Member States independently adopted specific tax regimes. The heterogenous tax 
regime in the EU has created uncertainties, burden and potential distortions in the commercialisation 
and movement of tobacco and related products.  

Using  Passport  data,  information  on  excise  duties  on  waterpipe  tobacco,  small  cigarillos  and  slim 
cigarettes  were  retrieved,  as  presented  in  the  separate  chapters  for  products  individually.140  Time 
series data was also analysed but no significant changes in tax policies were detected and no relevant 
findings emerged. Hence, the following analysis focusses on the most recent available data, i.e. 2017. 
The figure below represents the differences across the EU countries in terms of taxation of the specific 
categories of the tobacco products. 

140 Slim cigarettes have the same rate as cigarettes. 

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Consumer preference and perception of specific categories of tobacco and related products 

Figure 175 Taxes on tobacco products by countries in 2017  

Note: EU average is calculated for the countries were data was available. Where there is no bar, data was not available. 
Source: Passport, 2017  

The data shows that the highest excise tax on slim cigarettes is applied in Ireland, the UK and the 
Netherlands140. It is worth mentioning that slim cigarettes do not have their own excise tax but that 
they are the same as that for cigarettes The data on taxation of small cigarillos and waterpipe tobacco 
was not available for all the EU countries, but  among those with available information, the highest 
taxes on waterpipe tobacco were found to be in Sweden and Denmark. The EU average shows that 
small cigarillos were the least taxed product, with the notable exceptions of in Bulgaria, Belgium and 
Latvia. However, there were some differences across the countries. In Bulgaria and Belgium, the tax 
on  small  cigarillos  was  more  than  twice  that  of  other  tobacco  products,  and  in  Germany  tax  on 
waterpipe tobacco was  less than a third  of that applied to  small cigarillos and slim cigarettes. This 
may favour the formation of a black market (see section 2.2). Indeed, tax evasion has been found to 
be particularly high in the case of waterpipe tobacco, resulting in revenue loss and in the creation of 
a black market for the product, as reported by the European Commission.141  

According  to  this  same  study,  even  if  e-cigarettes  do  not  qualify  for  being  taxed  under  Directive 
2011/64, some Member States started to adopt ad-hoc consumption taxes on e-cigarettes since 2014. 
The precursors were Italy (2013) and Portugal (2014), later joined by Romania, Slovenia and Latvia. 
As of today, some nine Member States have applied ad-hoc taxes as summarised in the table below. 
The same study also noted that some countries have adopted various definitions of HTPs in regard to 
the tax scheme, resulting in many interpretations of how to implement the directive. The table below 
summarises these results. 

141 European Commission (2017): Study on Council Directive 2011/64/EU on the structure and rates of excise duty applied to 
manufactured tobacco. 

235 

050100150200250300350EUUKSKSISEROPTPLNLMTLVLULTITIEHUHRFRFIESELEEDKDECZCYBGBEATSmall cigarillos, euros per 1000 sticks050100150200250300350EUUKSKSISEROPTPLNLMTLVLULTITIEHUHRFRFIESELEEDKDECZCYBGBEATWaterpipe tobacco, euros per kg050100150200250300350EUUKSKSISEROPTPLNLMTLVLULTITIEHUHRFRFIESELEEDKDECZCYBGBEATSlim cigarettes,  euros per 1000 sticks 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Table 70. Overview of non-harmonised taxes for e-cigarettes and heated tobacco products 

Country 

Electronic Cigarettes 

Heated Tobacco Products 

PT 

IT 

RO 

SI 

LV 

HU 

FI 

EL 

HR 

SK 

€0.60/ml  nicotine  liquid,  reduced  to 
€0.30 since 01.01.2017 

€0.385/ml on all liquids, but  taxation 
of  non-nicotine 
liquids  has  been 
suspended after Constitutional Court’s 
ruling 83/2015 

Ad  valorem:  20%  of  RSP  (reduced  to  16%  in 
2017)  Specific:  €  78  /kg  (€80/kg  in  2017) 
Minimum Excise: €169/kg (as smoking tobacco) 

Depending on SKU: From € 63.25 to €63.36 per 
1,000 sticks (as 50% of cigarettes excise) 

RON  0.5/ml  nicotine 
€0.11/ml)  

liquid 

(ca. 

RON 384/kg (ca. €85) (as smoking tobacco) 

€0.18/ml nicotine liquid 

€ 88/kg (as FCT – minimum duty) 

€0.01/ml  of  e-liquid  +  €0.005/mg  of 
nicotine 

HUF  55/ml  (ca.  €0.18/ml)  since 
01.01.2017  (a  different  legislation 
may enter into force since April 2017, 
bringing the tax rate to HUF 65/ml)  

€ 62/kg (as smoking tobacco) 

HUF 10,000 per 1,000 sticks (€ 32.46) 

€0.30/ml  

€0.10/ml 

HRK 0.00/ml  

NA 

NA 

€ 156.7/kg (as smoking tobacco) 

HRK 600 / kg (ca. € 80.7) (as fine-cut tobacco) 

€ 73.9 / kg (as smoking tobacco) 

Source: European Commission 

The focus group results highlighted that users of different products were often mentioning price. They 
believed  that  the  prices  of  tobacco  and  related  products  were  high,  but  this  was  not  considered  a 
major drawback. Yet price-based policy measures such as increase in tobacco and related products 
taxes are unarguably the most effective means of reducing the consumption of tobacco. A 10% tax-
induced cigarette price increase anywhere in the world was expected to reduce smoking prevalence 
by between 4% and 8% (Epku & Brown, 2015). A publication by WHO (2018) highlighted that the 
large  price  increases  in  France  were  followed  by  declines  in  smoking  prevalence  and  lung  cancer 
deaths.  In  line  with  this,  the  United  Kingdom  successfully  raised  taxes  above  the  inflation  level, 
increased  the  revenues  from  tobacco  taxes  despite  consistent  drops  in  smoking  prevalence,  and 
reduced illicit trade at the same time. A meta-analysis review by Jawad et al. (2018) found  that a 
10% price increase would reduce demand, e.g. by 8.3% for cigars. It was suggested that this impact 
would mostly affect youth (Levy et al., 2018) and seem to be much more responsive to price changes 
of  the  product.  A  recent  study  found  that  increases  in  tobacco  tax,  warning  signs  on  packaging, 
restriction  of  tobacco  product  advertisements,  national  law  to  discourage  young  people,  and  peer-
based approaches to quit tobacco are popular policies (Ranabhat et al., 2019). Indeed, an often-cited 
reason for attempts to  quit was  “for economic  reasons” in our survey, although rarely as the  main 
reason.  

In  terms  of  health  impacts,  the  WHO  was  an  important  source  of  information  for  many  indicators, 
especially  mortality.  As  a  main  indicator,  compared  to  the  rest  of  the  world,  the  WHO  European 

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Region142  had  one  of  the  highest  percentages  of  deaths  attributable  to  tobacco  use.  The  WHO 
estimated  that  tobacco  use  was  responsible  for  16%  of  all  deaths  in  adults  over  30  in  the  region, 
many of these deaths being premature. This contrasts with the global average of 12% as well as with 
surrounding  regions.143  Many  studies  have  suggested  that  use  of  e-cigarettes  is  less  harmful  than 
conventional  smoking,  but  no  clinical  trials  have  proven  that  this  product  can  help  to  quit  tobacco 
consumption as opposed to other pharmaceutical products available on the market. In regard to HTPs, 
there was a great deal of uncertainty around the market size at the time of the study due to insufficient 
data,  but  the  market  appeared  to  be  growing  and  the  effects  to  health  remained  unknown.  The 
European Commission has closely followed the market developments of the newer products as they 
gained grip on the market. For example, the transposition of the new TPD in 2016 regulated e-cigarette 
marketing across the Union.  

The finding that younger generations are particularly susceptible to influences of design and prices of 
tobacco and related products (Laverty et al., 2016; Meernik et al., 2019) has raised concerns regarding 
youth pick-up rates of e-cigarettes and waterpipe tobacco consumption. These findings are consistent 
with  our  results,  in  which  the  youth  consistently  stated  trends  and  social  aspects  as  the  appealing 
factor that motivated their initiation to the use all products under the scope of this study. The design 
appeal is also observed for adults, but at a lesser degree. For example, our study found that the slim 
cigarette  packaging  was  viewed  as  more  convenient  (e.g.  “easier  to  transport”)  than  conventional 
cigarettes, while the designs of the non-conventional tobacco products was perceived as appealing 
(e.g. “very cute and nice”, “fun packaging”). Indeed, Laverty et al. (2016) found that younger people 
(15-24 years old) were more likely to cite external packaging and design as important features. HTPs 
have also been marketed and designed around eight themes specific to the device, namely, clinical 
purity,  a  closed  system,  premium  design,  sensory  invitations,  nostalgia  for  conventional  tobacco 
smoking, stability, familiar technology and normalisation (Hair, 2018).  

Plain packaging policies have been suggested as a measure to reduce the attractiveness of smoking, 
particularly among youths. France introduced this policy in 2017 – which has provided a natural setting 
to  test  the  impact  on  perceptions  of  branding  and  packaging.  El-Khoury  Lesueur  et  al.  (2018) 
examined changes in smoking-related perceptions and behaviours among French adolescents prior to 
(2016)  and  one-year  post  implementation  (2017).  He  found  that  youth  was  more  likely  to  report 
negative views of smoking (e.g. fear of the consequences). They also seemed to perceive it as less 
socially acceptable. Furthermore, smoking initiation had significantly decreased, with a less significant 
drop  in  current  tobacco  use.  This  finding  is  consistent  with  our  study,  during  which  participants  in 
France reported that the neutral packaging was less “attractive” or “fun” and more “austere”, whereas 
other products that had not been regulated in the same manner due to their novelty were subsequently 
and  implicitly  positively  highlighted.  These  findings  suggest  that  plain  packaging  may  also  be  an 
interesting  measure  to  reduce  the  marketing  advantage  of  certain  tobacco  and  related  products. 
Indeed,  consumption  of  slim  cigarettes  was  found  to  be  particularly  low  in  France  in  our  study  – 
ranking second to last in terms of consumption of the product, after Germany. Several reviews have 
concluded that plain packaging may reduce smoking prevalence, with the most consistent evidence 
for its role in reducing the appeal of the products. This finding is consistent across many studies on 
the impact of plain packaging (Greenhalgh, 2018). Furthermore, our study found that images on the 

142  Albania,  Andorra,  Armenia,  Austria,  Azerbaijan,  Belarus,  Belgium,  Bosnia  and  Herzegovina,  Bulgaria,  Croatia,  Cyprus, 
Czechia, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, 
Kyrgyzstan,  Latvia,  Lithuania,  Luxembourg,  Malta,  Monaco,  Montenegro,  Netherlands,  North  Macedonia,  Norway,  Poland, 
Portugal,  Republic  of  Moldova,  Romania,  Russian  Federation,  San  Marino,  Serbia,  Slovakia,  Slovenia,  Spain,  Sweden, 
Switzerland, Tajikistan, Turkey, Turkmenistan, Ukraine, United Kingdom of Great Britain and Northern Ireland and Uzbekistan 
143 
https://apps.who.int/iris/bitstream/handle/10665/44815/9789241564434_eng.pdf;jsessionid=888154B027B96ED6455C90F3
BDE539FB?sequence=1  

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Consumer preference and perception of specific categories of tobacco and related products 

packaging were not so influential among smokers – potentially because they had reportedly become 
accustomed to visualising these pictures. Rather, it was believed to possibly prevent new consumption 
of products. 

8  Conclusion  

The available evidence gathered during the systematic review and empirical research suggested the 
following points in regard to the main drivers of market developments and consumer perceptions for 
the five products under the scope of this study:  

  Slim cigarettes were marginally more used by females (58% of slim cigarette users in 18-25 
age group), while small cigarillos were mainly used by males (e.g. 70% of current consumers 
in 18-25 age group). Waterpipe tobacco had 62% of male users. The consumer base for other 
products  were  relatively  balanced  in  terms  of  gender.  The  focus  group  discussions  revealed 
that slim cigarettes were perceived as feminine as well as business-like, especially in eastern 
Member States, and small cigarillos were associated with masculinity. 

 

It is not easy to establish the reasons behind tobacco and related products  patterns  of use. 
Enjoyment,  stress  reduction,  sociability,  being  trendy  all  feature  in  users  accounts  of  their 
probably addiction to nicotine. Reduced health risk is one of the multiple drivers in the choice 
of certain products, even when there is no evidence of health risk reduction and the use of the 
product may lead to behaviours that are more damaging to health. As an example, some slim 
cigarette users said that they sometimes needed to consume more sticks to feel as satiated as 
they would with conventional cigarettes. 

  Small cigarillos were reported as being associated with social gatherings and special occasions. 
However, they were popular in some markets in part due to the flavouring of the product which 
has been banned for cigarettes and RYO in the TPD. This warrants the monitoring of market 
developments in the product. 

  Products were experienced differently by users. HTPs and e-cigarettes were viewed as a colder 
experience, more modern and technological, bult without the sense of satisfaction provided by 
conventional cigarettes. Slim cigarettes and small cigarillos were generally perceived as old-
fashioned (e.g. authentic, gender-oriented, etc.). Waterpipe tobacco was typically dissociated 
from other tobacco and related products as it is used in special premises and within a group. 
This is of concern as it may limit exposure of users to package health warnings. 

  Respondents  in  the  18-25  age  group  were  flagged  as  an  important  consumer  group  for 
waterpipe  tobacco,  with  the  majority  (53%)  having  at  least  tried  the  product  across  the 
surveyed countries. Waterpipe was also typically perceived to be mainly consumed by youth. 
The data indicated that respondents in the 18-25 age group began consumption of waterpipe 
tobacco products before the age of 18 years. 

  The online survey identified prevalent dual use among users with conventional cigarettes the 
second product of choice for the greater majority. Only a minority reported quitting all tobacco 
and related products and the greater majority of those who were using e-cigarettes or HTPs 
were using conventional cigarettes in parallel.  

  What have the survey findings contributed to the debate on whether e-cigarettes were an aid 
to  quitting  conventional  cigarettes  (the  cessation  scenario)  or  whether  young  people  would 
take up the use of e-cigarettes and progress to conventional cigarettes (the gateway scenario). 
Before looking at the survey evidence a note  of caution is needed. The online survey was a 
cross-sectional study and, as such, cannot lead to causal claims. 

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Consumer preference and perception of specific categories of tobacco and related products 

 

Just below 1 in 5 in both age groups said they had previously used other products but were 
now only using e-cigarettes. 1 in 12 of the younger age group and 1 in 25 of the older age 
group were exclusive e-cigarette users and had not used other products. Given that ‘cutting 
down or quitting other tobacco products’ was cited as a reason for taking up e-cigarettes, these 
findings were suggestive of the cessation scenario. However,  over 7 in 10 of the 18-25 age 
group and 8 in 10 of 26+ age group were dual users of e-cigarettes and other products, mainly 
conventional cigarettes.  

  Of past e-cigarette users, 1 in 4 in both age groups had been dual users and now were not 
using  any  tobacco  and  related  products.  This  is  suggestive  of  the  cessation  scenario. 
Suggestive of the gateway scenario, 1 in 4 of the 18-25 age group and 3 in 10 of the 26+ age 
group had been exclusive e-cigarette users and now reported using other tobacco and related 
products, with some 90% reporting the use of conventional cigarettes. Marginally more than 4 
in 10 of both age groups were past e-cigarette users and reported current dual use of other 
tobacco and related products. The use of e-cigarettes had not made an impact on their use of 
conventional tobacco. 

  Overall, the survey findings are suggestive of both cessation and gateway scenarios. This in 
the context of dual use reported by a substantial majority of the current e-cigarette users and 
by significant numbers of past e-cigarette users. 

  Since younger generations are increasingly less likely to smoke conventional tobacco products, 
tobacco companies have developed new products which are marketed as “safer” alternatives. 
There has been a proliferation of novel tobacco products entering the EU market. Of particular 
significance to the TPD are heated tobacco products (HTPs). They have been marketed in over 
40  countries  worldwide  as  of  July  2019,  with at  least  22  countries  from  the  WHO  European 
region. According to the few existing population surveys, the prevalence  of HTP current use 
among adults is less than 0.5% in the general population of European Union MS.  

  Heated  tobacco  products  (HTPs)  are  tobacco  products  that  produce  an  emission  containing 
nicotine and other chemicals, which is then inhaled by users. They have been marketed as so-
called potentially reduced risk exposure products, or even as modified-risk tobacco products. 
Currently,  there  is  insufficient  evidence  to  conclude  that  HTPs  are  less  harmful  than 
conventional cigarettes. There are concerns that while they may expose users to lower levels 
of some toxicants than conventional cigarettes, they also expose users to higher levels of other 
toxicants. It is still unclear how this toxicological profile translates into short- and long-term 
health effects.  

  According  to  Passport  data  (2017),  HTP  sales  were  769  million  euros.  The  leading  markets 
were Italy and Romania. Although there are no time series trend data on HTP sales or HTP use, 
the market size for HTP is expected to grow soon but there is still a big gap before it reaches 
the size of the market for conventional tobacco cigarettes (EC, 2017). 

  Marketing and promotion of HTPs has included alleviating health concerns through claims that 
HTPs are reduced-risk products; designing HTP systems to boost the user’s social image; using 
“bait  and  hook”  pricing  strategy;  employing  social  marketing  techniques  and  brand 
ambassadors;  selling  and  marketing  via  multiple  channels,  including dedicated  stores,  retail 
establishments and e-commerce websites. 

  Member States have adopted different definitions of HTPs with respect to taxes, resulting in 
substantial fragmentation of the EU internal market and resulting in a large variation in prices 
across European countries  

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  The  empirical  research  (focus  groups  and  online  survey)  revealed  that  HTPs  were  the  least 
known  product  among  the  products  under  study.  HTPs  and  electronic  cigarettes  were 
sometimes confused, considered to be similar products, and believed to not be as satisfying as 
conventional tobacco products.  

  Everyday use of HTPs with 1 to 10 sticks was typical for current users. Initiation of use was 
motivated by either enjoyment or trying to quit or reduce smoking of conventional .About 85% 
were dual users.  

  Current  HTP  users  were  evenly  split  between  those  than  had  never  attempted  quitting  and 
those who tried at least once and failed in the 18-25 group. In the 26+ group, almost two out 
of three had never tried to quit. Among failed quitters, the main reasons to try quitting were 
for  ‘personal  health’  and  ‘economic  reasons’.  In  the  26+  group,  another  reason  frequently 
mentioned was the ‘concern for the health of the people around them’. The main reason cited 
for failing to quit was being ‘stressed’. In the 26+ group, another important reason was that 
they found quitting HTPs ‘too difficult’. 

  The majority of past users of HTPs were still using other tobacco products at the time of the 

survey.   

  Health  risk  perception  of  the  five  tobacco  and  related  products  analysed  in  this  study  plus 
conventional cigarettes found the following. Conventional cigarettes were perceived to be the 
most harmful to the health of users and bystanders. Comparing the risk perception of users of 
conventional cigarettes with the users of HTPs, the 18-25 age group rated HTPs as 35% less 
harmful than conventional cigarettes to users and 46% less harmful to bystanders. In the 26+ 
age  group  HTPs  were  perceived  to  be  52%  less  harmful  to  users  and  58%  less  harmful  to 
bystanders. 

  About 75% of respondents agree that HTPs should be regulated as conventional cigarettes and 
a many support restrictions in use in workplaces, public transport and the hospitality sector.  

  Social  media  sites  have  enabled  indirect  product  promotion  (e.g.  through  user-generated 
content) which influences public opinions and perception and runs the risk of re-normalising 
smoking in the public. As a result, around one quarter of respondents for each age group [23-
25%]  reported  advertisements  as  a  factor  in  their  decision  to  start  using  HTPs.  The  overall 
perception  of  e-cigarettes  and  HTPs  appeared  to  be  marked  by  social  factors,  including 
marketing practices.  

  Focus groups participants raised concern over the influence of marketing practices and product 
designs on attracting the youth. In the online survey, a majority of respondents of both age 
groups strongly believed that the youth was a vulnerable target group for HTPs (70% 18-25 
age group; 66% 26+ age group) and electronic cigarettes (80% 18-25 age group; 76% 26+ 
age group). Packaging and design were found to influence consumption prevalence, especially 
in younger generations (Laverty et al., 2016; Meernik et al., 2019). El-Khoury Lesueur et al. 
(2018) demonstrated that the implementation of standardised cigarette appearance reduced 
the appeal of cigarettes in adolescents and reduced the opportunity for stick design to mislead 
young  smokers  in  terms  of  harm.  In  addition,  flavours  have  been  marketed  in  products  for 
which the TPD has not banned flavours. Accordingly, the focus group discussions revealed that 
flavours were an important feature to consumers of e-cigarettes, waterpipe tobacco and small 
cigarillos. Flavour and trends were stated as important influences, also on social media (e.g. 
Instagram). The focus group findings warrant for close monitoring of the market developments, 
especially of these features.  

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  The 18-25 age group had a tendency to perceive higher health risks from tobacco and related 
products than the 26+ age group. Current research has concluded that none of the products 
under  study  were  risk-free  and  while  HTPs  and  e-cigarettes  are  considered  relatively  less 
harmful than conventional cigarettes, the longer-term health impacts of these new products 
have  yet  to  be  ascertained.  Research  provided  no  indication  that  slim  cigarettes,  waterpipe 
tobacco and small cigarillos should be considered less harmful than conventional cigarettes. It 
is of concern that users of these products consider them to ‘safer’ than conventional cigarettes.  

In addition to the main drivers of market developments and consumer perceptions, this study also 
considered the health, social and economic impacts144. Emerging new products are distinguishable by 
the nature of their emissions and increasingly being used by those who share the perception that they 
are “healthier options” compared to traditional tobacco products such as cigarettes. This despite the 
absence of evidence that these products are ‘healthier’ and that most regulators in the EU and beyond 
have taken a precautionary approach to these products . E-cigarette companies have enhanced the 
appeal of their offerings by advancing the efficiency of nicotine delivery, but also by adding appealing 
flavourings.145 Further studies are needed to clarify health, social and economic impacts. 

Novel and emerging tobacco products, above all, HTPs, pose particular challenges to the application 
of  TAPS  bans  and  restrictions.  The  devices  are  aggressively  marketed  in  many  Member  States’ 
providing the appearance of a healthier product and normalising the promotion and use of tobacco 
products.  Challenges  arise  in  particular  from  the  increasing  use  of  the  internet  and  social  media 
platforms for covert and indirect advertising, which, it has been suggested, the industry increasingly 
uses to exploit legal loopholes to circumvent prohibitions.  

Despite the identified gaps in evidence and the dynamic of evolving patterns of the use of e-cigarettes 
and novel tobacco products, policy options are needed that ensure protection of the public at large, 
both  users  and  potential  users.  A  major  challenge  from  a  public  health  perspective  appears  to  be 
balancing potential “harm reduction” claims of certain products, where the evidence is still mixed, and 
the  ethical  issue  of  substituting  an  addictive  and  health  harmful  product  with  a  new  addictive  and 
putatively less health harmful product. For example, the potential of e-cigarettes to act as a gateway 
to  smoking  or  as  an  attractive  alternative  to  conventional  tobacco  products  in  particular  for  young 
people has been evidenced in the literature and in the current research. E-cigarettes were found to 
simulate smoking behaviour and can lead to further experimentation with other nicotine-containing 
products. Recent studies suggest that e-cigarettes are increasingly used by non-smokers and young 
people.  For  example,  a  French  study  of  2013  revealed  that  the  number  of  Parisian  students 
experimenting  with  e-cigarettes  has  doubled  in  one  year  reaching  18%.146  Governments  across 
Member States have become increasingly concerned over the appeal of e-cigarette use among young 
people. The balance between risks and potential harm reduction benefits of e-cigarette use depends 
on its gateway impacts among youth and users at large as well as the actual harm of those products. 
It  is  clear  that  the  assessment  of  ‘actual  harm’  and  longer-term  impacts  of  the  use  has  yet  to  be 
established. 

Overall,  policy  efforts  related  to  tobacco  control  have  been  advancing  worldwide,  and  the  EU  and 
Member  States  have  implemented  a  number  of  legal  and  financial  measures  to  reduce  the 
consumption of tobacco and related products. The extensive list of adopted tobacco control laws and 
policies  across  countries  (e.g.  Andersen,  Becher  &  Winkler,  2016)  supports  data  related  to  recent 

144 See sections 2.4, 3.4, 4.4, 5.4 and 6.4. 
145 National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. E-Cigarette Use 
Among Youth and Young Adults: A Report of the Surgeon General [Internet]. Atlanta (GA): Centers for Disease Control and 
Prevention (US); 2016. Chapter 5, E-Cigarette Policy and Practice Implications.  
146 https://ec.europa.eu/health/sites/health/files/tobacco/docs/tobacco_mythbuster_en.pdf  

241 

 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

trends that prove increased  efforts to  ratify and implement the Framework Convention on  Tobacco 
Control (FCTC), which legally binds signatory states to implement its articles.  However, in order to 
determinate  the  critical  balance  for  public  health  between  the  harms  and  potential  benefits  of  e-
cigarettes and other novel tobacco related products, more evidence is needed.  

Article 28 of the Directive specifies that the Commission should pay special attention to novel tobacco 
products and electronic cigarettes and refill containers, cigarettes with a diameter of less than 7,5 mm 
and  waterpipe  tobacco.  This  study  has  investigated  the  market  developments,  initiation  of  use  of 
products by young and older people, cessation efforts, consumer perceptions, as well as considerations 
around use of flavours in some of these products. The results reported  are intended to support the 
Commission by assessing how specific product categories are perceived by the public, what impacts 
they may have, and mapping consumer preferences and use patterns of these products. The evidence 
gathered here will help inform policymakers for potential next steps in tobacco control policies with 
the ultimate aim of protecting public health. 

242 

 
 
 
 
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250 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

10  Annexes 

10.1 Background 

Table 71. online survey sample description (18-25 age group) 

(number & (percentage) – of all respondents in the 18-25 age group) 

18-25 
group  

age 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

Total (n) 

6,090 

610 

603 

610 

605 

606 

601 

603 

609 

643 

600 

Gender 

Male 

% 

2,869 

290 

262 

298 

298 

305 

300 

234 

301 

280 

301 

47.1 

47.5 

43.4 

48.9 

49.3 

50.3 

49.9 

38.8 

49.4 

43.5 

50.2 

Female 

3,221 

320 

341 

312 

307 

301 

301 

369 

308 

363 

299 

% 

52.9 

52.5 

56.6 

51.1 

50.7 

49.7 

50.1 

61.2 

50.6 

56.5 

49.8 

Education 

No 
education 

official 

84 

9 

8 

8 

6 

20 

5 

11 

6 

2 

9 

% 

1.4 

1.5 

1.3 

1.3 

1.0 

3.3 

0.8 

1.8 

1.0 

0.3 

1.5 

Primary school 

251 

19 

13 

6 

14 

34 

21 

48 

21 

54 

21 

% 

4.1 

3.1 

2.2 

1.0 

2.3 

5.6 

3.5 

8.0 

3.4 

8.4 

3.5 

High school 

2,049 

190 

209 

35 

145 

169 

272 

200 

315 

302 

212 

% 

33.6 

31.1 

34.7 

5.7 

24.0 

27.9 

45.3 

33.2 

51.7 

47.0 

35.3 

Some  years  of 
university 

1,780 

195 

228 

305 

211 

107 

150 

159 

132 

125 

168 

% 

29.2 

32.0 

37.8 

50.0 

34.9 

17.7 

25.0 

26.4 

21.7 

19.4 

28.0 

University degree 

1,509 

136 

119 

213 

160 

184 

119 

142 

122 

156 

158 

% 

24.8 

22.3 

19.7 

34.9 

26.4 

30.4 

19.8 

23.5 

20.0 

24.3 

26.3 

Post-graduate 

417 

61 

26 

43 

69 

92 

34 

43 

13 

4 

32 

% 

6.8 

10.0 

4.3 

7.0 

11.4 

15.2 

5.7 

7.1 

2.1 

0.6 

5.3 

Employment 
Status 

Self-employed 

543 

83 

24 

79 

65 

56 

44 

68 

37 

30 

57 

% 

8.9 

13.6 

4.0 

13.0 

10.7 

9.2 

7.3 

11.3 

6.1 

4.7 

9.5 

251 

 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Consumer preference and perception of specific categories of tobacco and related products 

18-25 
group  

age 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

Managerial 
position 

% 

Other 
collar 

% 

358 

49 

23 

13 

20 

31 

12 

48 

40 

37 

85 

5.9 

8.0 

3.8 

2.1 

3.3 

5.1 

2.0 

8.0 

6.6 

5.8 

14.2 

white 

1,084 

123 

105 

94 

123 

93 

90 

153 

119 

79 

105 

17.8 

20.2 

17.4 

15.4 

20.3 

15.3 

15.0 

25.4 

19.5 

12.3 

17.5 

Manual worker 

779 

96 

134 

23 

63 

80 

33 

52 

104 

87 

107 

% 

12.8 

15.7 

22.2 

3.8 

10.4 

13.2 

5.5 

8.6 

17.1 

13.5 

17.8 

Unemployed 

528 

51 

18 

82 

57 

28 

72 

61 

43 

51 

65 

% 

8.7 

8.4 

3.0 

13.4 

9.4 

4.6 

12.0 

10.1 

7.1 

7.9 

10.8 

Retired 

36 

4 

8 

3 

2 

3 

1 

5 

2 

6 

2 

% 

0.6 

0.7 

1.3 

0.5 

0.3 

0.5 

0.2 

0.8 

0.3 

0.9 

0.3 

Student 

2,545 

191 

276 

304 

269 

257 

328 

187 

254 

329 

150 

% 

41.8 

31.3 

45.8 

49.8 

44.5 

42.4 

54.6 

31.0 

41.7 

51.2 

25.0 

Non-employed 

217 

13 

15 

12 

6 

58 

21 

29 

10 

24 

29 

% 

3.6 

2.1 

2.5 

2.0 

1.0 

9.6 

3.5 

4.8 

1.6 

3.7 

4.8 

Residency 

Urban 

% 

3,949 

532 

327 

462 

444 

354 

330 

440 

408 

378 

274 

64.8 

87.2 

54.2 

75.7 

73.4 

58.4 

54.9 

73.0 

67.0 

58.8 

45.7 

Suburban 

1,173 

49 

113 

96 

104 

125 

177 

97 

101 

52 

259 

% 

Rural 

% 

19.3 

8.0 

18.7 

15.7 

17.2 

20.6 

29.5 

16.1 

16.6 

8.1 

43.2 

968 

29 

163 

52 

57 

127 

94 

66 

100 

213 

67 

15.9 

4.8 

27.0 

8.5 

9.4 

21.0 

15.6 

10.9 

16.4 

33.1 

11.2 

Self-reported socio-economic status 

1 lowest 

53 

8 

4 

7 

5 

6 

1 

6 

2 

5 

9 

% 

2 

% 

3 

0.9 

1.3 

0.7 

1.1 

0.8 

1.0 

0.2 

1.0 

0.3 

0.8 

1.5 

122 

11 

5 

8 

2 

21 

13 

18 

16 

5 

23 

2.0 

1.8 

0.8 

1.3 

0.3 

3.5 

2.2 

3.0 

2.6 

0.8 

3.8 

351 

36 

14 

39 

17 

46 

26 

32 

42 

39 

60 

252 

 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Consumer preference and perception of specific categories of tobacco and related products 

18-25 
group  

age 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

% 

4 

% 

5 

% 

6 

% 

7 

% 

8 

% 

9 

% 

5.8 

5.9 

2.3 

6.4 

2.8 

7.6 

4.3 

5.3 

6.9 

6.1 

10.0 

600 

79 

43 

69 

46 

53 

43 

66 

62 

78 

61 

9.9 

13.0 

7.1 

11.3 

7.6 

8.7 

7.2 

10.9 

10.2 

12.1 

10.2 

1,145 

139 

80 

118 

100 

96 

105 

85 

155 

146 

121 

18.8 

22.8 

13.3 

19.3 

16.5 

15.8 

17.5 

14.1 

25.5 

22.7 

20.2 

1,439 

140 

124 

165 

164 

127 

142 

160 

146 

154 

117 

23.6 

23.0 

20.6 

27.0 

27.1 

21.0 

23.6 

26.5 

24.0 

24.0 

19.5 

1,370 

120 

185 

123 

150 

122 

157 

142 

123 

141 

107 

22.5 

19.7 

30.7 

20.2 

24.8 

20.1 

26.1 

23.5 

20.2 

21.9 

17.8 

618 

43 

98 

48 

74 

73 

68 

58 

38 

54 

64 

10.1 

7.0 

16.3 

7.9 

12.2 

12.0 

11.3 

9.6 

6.2 

8.4 

10.7 

209 

13 

31 

19 

25 

32 

27 

14 

17 

11 

20 

3.4 

2.1 

5.1 

3.1 

4.1 

5.3 

4.5 

2.3 

2.8 

1.7 

3.3 

10 highest 

183 

21 

19 

14 

22 

30 

19 

22 

8 

10 

18 

% 

3.0 

3.4 

3.2 

2.3 

3.6 

5.0 

3.2 

3.6 

1.3 

1.6 

3.0 

Source: OE elaboration from online survey data 

253 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 72. online survey sample description (26+ age group) 

(number & (percentage) – of all respondents in the 26+ age group) 

26+ 
group  

age 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

Total 

Gender 

Male 

% 

5,910 

590 

597 

590 

595 

594 

599 

597 

591 

557 

600 

3,074 

301 

338 

298 

299 

279 

294 

371 

287 

315 

292 

52.0 

51.0 

56.6 

50.5 

50.3 

47.0 

49.1 

62.1 

48.6 

56.6 

48.7 

Female 

2,836 

289 

259 

292 

296 

315 

305 

226 

304 

242 

308 

% 

48.0 

49.0 

43.4 

49.5 

49.7 

53.0 

50.9 

37.9 

51.4 

43.4 

51.3 

Education 

No 
education 

official 

37 

1 

2 

5 

0 

17 

3 

3 

2 

1 

3 

% 

0.6 

0.2 

0.3 

0.8 

0.0 

2.9 

0.5 

0.5 

0.3 

0.2 

0.5 

Primary school 

271 

7 

82 

3 

12 

66 

49 

24 

11 

10 

7 

% 

4.6 

1.2 

13.7 

0.5 

2.0 

11.1 

8.2 

4.0 

1.9 

1.8 

1.2 

High school 

2,041 

123 

265 

87 

159 

179 

248 

193 

221 

303 

263 

% 

34.5 

20.8 

44.4 

14.7 

26.7 

30.1 

41.4 

32.3 

37.4 

54.4 

43.8 

Some  years  of 
university 

663 

67 

99 

100 

77 

41 

53 

84 

31 

49 

62 

% 

11.2 

11.4 

16.6 

16.9 

12.9 

6.9 

8.8 

14.1 

5.2 

8.8 

10.3 

University degree 

2,005 

199 

111 

288 

251 

203 

139 

210 

246 

179 

179 

% 

33.9 

33.7 

18.6 

48.8 

42.2 

34.2 

23.2 

35.2 

41.6 

32.1 

29.8 

Post-graduate 

893 

193 

38 

107 

96 

88 

107 

83 

80 

15 

86 

% 

15.1 

32.7 

6.4 

18.1 

16.1 

14.8 

17.9 

13.9 

13.5 

2.7 

14.3 

Employment 
status 

Self-employed 

819 

105 

57 

111 

96 

71 

110 

90 

63 

60 

56 

% 

13.9 

17.8 

9.5 

18.8 

16.1 

12.0 

18.4 

15.1 

10.7 

10.8 

9.3 

Managerial 
position 

749 

87 

75 

43 

80 

25 

43 

93 

97 

62 

144 

% 

12.7 

14.7 

12.6 

7.3 

13.4 

4.2 

7.2 

15.6 

16.4 

11.1 

24.0 

254 

 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Consumer preference and perception of specific categories of tobacco and related products 

26+ 
group  

age 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

Other white collar 

1,790 

219 

132 

240 

214 

160 

209 

167 

205 

134 

110 

% 

30.3 

37.1 

22.1 

40.7 

36.0 

26.9 

34.9 

28.0 

34.7 

24.1 

18.3 

Manual worker 

941 

98 

105 

40 

104 

122 

44 

101 

115 

140 

72 

% 

15.9 

16.6 

17.6 

6.8 

17.5 

20.5 

7.3 

16.9 

19.5 

25.1 

12.0 

Unemployed 

400 

23 

40 

96 

37 

33 

58 

39 

16 

21 

37 

% 

Retired 

% 

6.8 

3.9 

6.7 

16.3 

6.2 

5.6 

9.7 

6.5 

2.7 

3.8 

6.2 

718 

36 

136 

36 

31 

102 

38 

55 

65 

106 

113 

12.1 

6.1 

22.8 

6.1 

5.2 

17.2 

6.3 

9.2 

11.0 

19.0 

18.8 

Student 

106 

8 

15 

12 

10 

4 

25 

9 

10 

5 

8 

% 

1.8 

1.4 

2.5 

2.0 

1.7 

0.7 

4.2 

1.5 

1.7 

0.9 

1.3 

Non-employed 

387 

14 

37 

12 

23 

77 

72 

43 

20 

29 

60 

% 

6.5 

2.4 

6.2 

2.0 

3.9 

13.0 

12.0 

7.2 

3.4 

5.2 

10.0 

Residency 

Urban 

% 

3,879 

553 

313 

474 

476 

272 

385 

429 

459 

354 

164 

65.6 

93.7 

52.4 

80.3 

80.0 

45.8 

64.3 

71.9 

77.7 

63.6 

27.3 

Suburban 

1,010 

21 

116 

79 

69 

101 

131 

79 

65 

47 

302 

% 

Rural 

% 

17.1 

3.6 

19.4 

13.4 

11.6 

17.0 

21.9 

13.2 

11.0 

8.4 

50.3 

1,021 

16 

168 

37 

50 

221 

83 

89 

67 

156 

134 

17.3 

2.7 

28.1 

6.3 

8.4 

37.2 

13.9 

14.9 

11.3 

28.0 

22.3 

Self-reported socio-economic status 

1 lowest 

71 

8 

5 

5 

6 

10 

11 

15 

0 

4 

7 

% 

2 

% 

3 

% 

4 

% 

1.2 

1.4 

0.8 

0.8 

1.0 

1.7 

1.8 

2.5 

0.0 

0.7 

1.2 

205 

29 

15 

8 

11 

28 

17 

32 

12 

21 

32 

3.5 

4.9 

2.5 

1.4 

1.8 

4.7 

2.8 

5.4 

2.0 

3.8 

5.3 

433 

49 

32 

28 

24 

61 

30 

49 

56 

45 

59 

7.3 

8.3 

5.4 

4.7 

4.0 

10.3 

5.0 

8.2 

9.5 

8.1 

9.8 

665 

74 

59 

77 

42 

57 

55 

76 

65 

81 

79 

11.3 

12.5 

9.9 

13.1 

7.1 

9.6 

9.2 

12.7 

11.0 

14.5 

13.2 

255 

 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Consumer preference and perception of specific categories of tobacco and related products 

26+ 
group  

age 

Group 
total 

BG 

DE 

EL 

ES 

FR 

IT 

LV 

PL 

SK 

UK 

5 

% 

6 

% 

7 

% 

8 

% 

9 

% 

1,254 

159 

102 

128 

114 

134 

108 

120 

139 

127 

123 

21.2 

26.9 

17.1 

21.7 

19.2 

22.6 

18.0 

20.1 

23.5 

22.8 

20.5 

1,365 

136 

131 

138 

161 

130 

162 

134 

132 

117 

124 

23.1 

23.1 

21.9 

23.4 

27.1 

21.9 

27.0 

22.4 

22.3 

21.0 

20.7 

1,150 

86 

122 

135 

146 

93 

128 

115 

117 

101 

107 

19.5 

14.6 

20.4 

22.9 

24.5 

15.7 

21.4 

19.3 

19.8 

18.1 

17.8 

528 

30 

93 

48 

59 

49 

60 

43 

46 

46 

54 

8.9 

5.1 

15.6 

8.1 

9.9 

8.2 

10.0 

7.2 

7.8 

8.3 

9.0 

131 

8 

21 

11 

22 

16 

11 

5 

16 

10 

11 

2.2 

1.4 

3.5 

1.9 

3.7 

2.7 

1.8 

0.8 

2.7 

1.8 

1.8 

10 highest 

108 

11 

17 

12 

10 

16 

17 

8 

8 

5 

4 

% 

1.8 

1.9 

2.8 

2.0 

1.7 

2.7 

2.8 

1.3 

1.4 

0.9 

0.7 

Source: OE elaboration from online survey data 

256 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

10.2 Waterpipe tobacco products  

Figure 176. Duration of use of past users (waterpipe; 18-25 age group) 

(number of past users in the 18-25 age group) 

Base: past users of waterpipe tobacco in the 18-25 age group (N=845147) 
Question: Q.1.2.a. At about what age did you start using waterpipe tobacco? & Q.1.2.b. At about 
what age did you stop using waterpipe tobacco? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was 
a past user of the product. The mean shows the average duration of use.  
Source: OE elaboration from online survey data 

Figure 177. Duration of use of past users (waterpipe; 26+ age group) 

(number of past users in the 26+ age group) 

Base: past users of waterpipe tobacco in the 26+ age group (N=424148) 

147 NA and misreported values are excluded. 
148 NA and misreported values are excluded. 

257 

 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Question: Q.1.2.a. At about what age did you start using waterpipe tobacco? & Q.1.2.b. At about 
what age did you stop using waterpipe tobacco? 
Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that was 
a past user of the product. The mean shows the average duration of use.  
Source: OE elaboration from online survey data 

Figure 178. Initiation of waterpipe use: reasons (18-25 age group) 

(% (number)- of users in the 18-25 age group) 

Base: current and past users of waterpipe tobacco in the 18-25 age group (N=1,581)  
Question: Q.2.1.a. Why did you start using waterpipe tobacco? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. 
The percentages do not add up to 100% because respondents could select more than one term.  
Source: OE elaboration from online survey data 

258 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 179. Initiation of waterpipe use: reasons (26+ age group) 

(% (number)- of current & past users in 26+ age group) 

Base: current and past users of waterpipe tobacco in the 26+ age group (N=803)  
Question: Q.2.1.a. Why did you start using waterpipe tobacco? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. 
The percentages do not add up to 100% because respondents could select more than one term.  
Source: OE elaboration from online survey data 

259 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 180. Initiation of waterpipe use: reasons for trying (waterpipe; 18-25 age group) 

(% (number)- of those who tried once or twice in the 18-25 age group) 

Base: those who tried to use waterpipe tobacco in the 18-25 age group (N=1,662)  
Question: Q.2.1.b. Why did you try waterpipe tobacco? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. 
The percentages do not add up to 100% because of the fact that respondents could select more 
than one term – therefore, the bars must be interpreted separately.  
Source: OE elaboration from study survey data 

260 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 181. Initiation of waterpipe use: reasons for trying (waterpipe; 26+ age group) 

(% (number)- of those who tried once or twice in the 26+ age group) 

Base: those who tried to use waterpipe tobacco once or twice in the 26+ age group (N=1,268)  
Question: Q.2.1.b. Why did you try waterpipe tobacco? Please select up to 2 options. 
Note: Each bar represents the share of respondents that selected the option within the age group. 
The percentages do not add up to 100% because of the fact that respondents could select more 
than one term – therefore, the bars must be interpreted separately.  
Source: OE elaboration from online survey data 

261 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 182. Representation of career flows for current user (waterpipe tobacco; 18-25 age 
group) 

Base: current users of waterpipe tobacco (excluding never users of other products) in 
the 18-25 age group (N=668) 

Question: Q.1.1. Have you ever used waterpipe tobacco? 

Note: The diagram is a simplified version of the career flows of dual waterpipe tobacco users, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

262 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 183. Representation of career flows for current user (waterpipe tobacco; 26+ age 
group) 

Base: current users of waterpie tobacco (excluding never users of other products) in 
the 26+ age group (N=339) 

Question: Q.1.1. Have you ever used waterpipe tobacco? 

Note: The diagram is a simplified version of the career flows of dual waterpipe tobacco users, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

263 

 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 184 Representation of career flows for past user (waterpipe tobacco; 18-25 age group) 

Base: past users of waterpipe tobacco (excluding never users of other products) in the 
18-25 age group (N=913) 

Question: Q.1.1. Have you ever used waterpipe tobacco? 

Note: The diagram is a simplified version of the career flows of dual waterpipe tobacco users, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

264 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 185 Representation of career flows for past user (waterpipe tobacco; 26+ age group) 

Base: past users of waterpipe tobacco (excluding never users of other products) in the 
26+ age group (N=464) 

Question: Q.1.1. Have you ever used waterpipe tobacco? 

Note: The diagram is a simplified version of the career flows of dual waterpipe tobacco users, i.e. it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

265 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 73. Perceived appeal of product to youth (waterpipe; 18-25 age group)  

(% - of respondents in the 18-25 age group) 

Group 
total  

Current 
users 

Past users  Used once 

or twice 

Never 
used 

Use of product 

100 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

42 

30 

14 

6 

7 

11 

14 

9 

9 

11 

6 

15 

16 

15 

14 

19 

7 

27 

31 

29 

24 

18 

16 

47 

39 

48 

53 

52 

72 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.16. Do you think that young people might be particularly attracted to waterpipe (e.g. 
shisha & narghile) tobacco, or not? 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total category refers to the total respondents in the 18-25 age group. 
Source: OE elaboration from online survey data 

Table 74. Perceived appeal of product to youth (waterpipe; 26+ age group)  

(% - of respondents in the 26+ age group) 

Group 
total  

Current 
users 

Past users  Used once 

or twice 

Never 
used 

Use of product 

100 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

29 

35 

18 

7 

11 

6 

8 

6 

4 

5 

2 

8 

9 

9 

6 

6 

4 

21 

24 

25 

20 

12 

12 

65 

59 

60 

69 

77 

83 

Base: respondents in the 26+ age group (N=5,910) 

Question: Q.4.16. Do you think that young people might be particularly attracted to 
waterpipe (e.g. shisha & narghile) tobacco, or not? 

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells  in  each  row  should  add  up  to  100).  The  group  total  column  refers  to  the  total 
respondents in the 26+ age group. 
Source: OE elaboration from online survey data 

266 

 
 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 75. Extent to which respondents believed that youth underestimate risks of using 
waterpipe tobacco (18-25 age group)  

(%- of respondents in the 18-25 age group) 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total  

100 

37 

33 

15 

7 

7 

Current 
users 

Past users  Used once 

or twice 

Never 
used 

11 

12 

10 

11 

12 

6 

15 

14 

16 

19 

17 

8 

27 

27 

28 

30 

30 

18 

47 

47 

46 

40 

41 

68 

Base: respondents in the 18-25 age group (N=6,090) 

Question:  Q.4.17.  Do  you  think  that  young  people  might  underestimate  the  risk  of 
using to waterpipe (e.g. shisha & narghile) tobacco, or not?  

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 18-25 age group. 

Source: OE elaboration from online survey data 

Table 76. Extent to which respondents believed that youth underestimate risks of using 
waterpipe tobacco (26+ age group) 

(%- of respondents in the 26+ age group) 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total  

100 

33 

38 

14 

6 

9 

Current 
users 

Past users  Used once 

or twice 

Never 
used 

6 

6 

6 

6 

5 

3 

8 

7 

8 

11 

10 

4 

21 

18 

22 

29 

25 

14 

65 

68 

64 

54 

59 

79 

Base: respondents in the 26+ age group (N=5,910) 

Question:  Q.4.17.  Do  you  think  that  young  people  might  underestimate  the  risk  of 
using to waterpipe (e.g. shisha & narghile) tobacco, or not?  

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 26+ age group. 

Source: OE elaboration from online survey data 

267 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

10.3 Slim cigarettes 

Figure 186. Average number of slim cigarette sticks per day of use, daily users (18-25 age 
group) 

(% (number)-of current daily users in the 18-25 age group) 

Base: daily current users of slim cigarettes in the 18-25 age group (N=388) 

Question: Q.1.4.a. On the days that you use slim cigarettes, about how much do you 
use? 

Source: OE elaboration from online survey data 

268 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 187. Average number of slim cigarettes sticks per day, for daily users (26+ age group) 

(% (number)-of current daily users in the 26+ age group) 

Base: daily current users of slim cigarettes in the 26+ age group (N=400) 

Question: Q.1.4.a. On the days that you use slim cigarettes, about how much do you 
use? 

Source: OE elaboration from online survey data 

269 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 188. Cessation: slim cigarettes quit attempts (slim cigarettes; 18-25 age group) 

 (% (number)- of current users in the 18-25 age group) 

Base: current users of slim cigarettes in the 18-25 age group (N=656)  

Question: Q.1.5. Have you ever tried to quit slim cigarettes? If yes, how many times? 

Source: OE elaboration from online survey data 

Figure 189. Cessation: slim cigarettes quit attempts (slim cigarettes; 26+ age group) 

 (% (number)- of current users in the 26+ age group) 

Base: current users of slim cigarettes in the 26+ age group (N=725)  

Question: Q.1.5. Have you ever tried to quit slim cigarettes? If yes, how many times? 

Source: OE elaboration from online survey data 

270 

 
 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 190. Representation of career flows for current users (slim cigarettes; 18-25 age group) 

Base: current users of slim cigarettes (excluding never users of other products) in the 
18-25 age group (N=622) 

Question: Q.1.1. Have you ever used slim cigarettes? 

Note:  The  diagram  is  a  simplified  version  of  the  career  flows  of  dual  slim  cigarette  users,  i.e.  it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data  

271 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 191. Representation of career flows for current users (slim cigarettes; 26+ age group) 

Base: current users of slim cigarettes (excluding never users of other products) in the 
26+ age group (N=691) 

Question: Q.1.1. Have you ever used slim cigarettes? 

Note:  The  diagram  is  a  simplified  version  of  the  career  flows  of  dual  slim  cigarette  users,  i.e.  it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

272 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 192. Representation of career flows for past users (slim cigarettes; 18-25 age group) 

Base: past users of slim cigarettes (excluding never users of other products) in the 18-
25 age group (N=771)  

Question: Q.1.1. Have you ever used slim cigarettes? 

Note:  The  diagram  is  a  simplified  version  of  the  career  flows  of  dual  slim  cigarette  users,  i.e.  it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

273 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 193. Representation of career flows for past users (slim cigarettes; 26+ age group) 

Base:  past  users  of  slim  cigarettes  (excluding  never  users  of  other  products)  in the 
26+ age group (N=840) 

Question: Q.1.1. Have you ever used slim cigarettes? 

Note:  The  diagram  is  a  simplified  version  of  the  career  flows  of  dual  slim  cigarette  users,  i.e.  it 
highlights dual use patterns as well as transitions to/from other products; therefore, never users of 
other products were excluded. The thickness/width of the tails, as well as the percentages included, 
are  only  indicative.  Some  individuals  may  be  represented  twice  (or  more)  if  they  use/have  used 
more than one product at a time.  

Source: OE elaboration from online survey data 

274 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

10.4 Novel tobacco products 

Figure 194. Duration of use of past users (HTPs; 18-25 age group) 

(number of past users in the 18-25 age group) 

Base: past HTP users in the 18-25 age group (N=378149) 

Question: Q.1.2.a. At about what age did you start using HTPs? & Q.1.2.b. At about what age 
did you stop using HTPs? 

Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that 
was a past user of the product. The mean shows the average duration of use. We cut off the 
data at 5 years, since the product was introduced in 2014. 

Source: OE elaboration from online survey data 

Figure 195. Duration of use of past users (HTPs; 26+ age group) 

(number of past users in the 26+ age group) 

Base: past HTP users in the 26+ age group (N=222150) 

149 NA and misreported values are excluded. 
150 NA and misreported values are excluded. 

275 

 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Question: Q.1.2.a. At about what age did you start using HTPs? & Q.1.2.b. At about what age 
did you stop using HTPs? 

Note: The duration was calculated by subtracting Q.1.2.a. from Q.1.2.b for each individual that 
was a past user of the product. The mean shows the average duration of use. We cut off the 
data at 5 years, since the product was introduced in 2014 in Italy. 

Source: OE elaboration from online survey data 

Figure 196. Representation of career flows for current users (HTPs; 18-25 age group) 

Base:  current users  of  HTPs  (excluding  never  users  of  other  products)  in  the  18-25 
age group (N=498) 

Question: Q.1.1. Have you ever used HTPs? 

Note: The diagram is a simplified version of the career flows of dual HTP users, i.e. it highlights dual 
use patterns as well as transitions to/from other products; therefore, never users of other products 
were  excluded.  The  thickness/width  of  the  tails,  as  well  as  the  percentages  included,  are  only 
indicative. Some individuals may be represented twice (or more) if they use/have used more than 
one product at a time.  

Source: OE elaboration from online survey data 

276 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 197. Representation of career flows for current users (HTPs; 26+ age group)  

Base: current users of HTPs (excluding never users of other products) in the 26+ age 
group (N=627)  

Question: Q.1.1. Have you ever used HTPs? 

Note: The diagram is a simplified version of the career flows of dual HTP users, i.e. it highlights dual 
use patterns as well as transitions to/from other products; therefore, never users of other products 
were  excluded.  The  thickness/width  of  the  tails,  as  well  as  the  percentages  included,  are  only 
indicative. Some individuals may be represented twice (or more) if they use/have used more than 
one product at a time.  

Source: OE elaboration from online survey data151 

151 http://sankey-diagram-generator.acquireprocure.com 

277 

 
 
 
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Figure 198. Representation of career flows for past users (HTPs; 18-25 age group) 

Base: past users of HTPs (excluding never users of other products) in the 18-25 age 
group (N=443)  

Question: Q.1.1. Have you ever used HTPs? 

Note: The diagram is a simplified version of the career flows of dual HTP users, i.e. it highlights dual 
use patterns as well as transitions to/from other products; therefore, never users of other products 
were  excluded.  The  thickness/width  of  the  tails,  as  well  as  the  percentages  included,  are  only 
indicative. Some individuals may be represented twice (or more) if they use/have used more than 
one product at a time.  

Source: OE elaboration from online survey data 

278 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 199. Representation of career flows for past users (HTPs; 26+ age group) 

Base: current users of HTPs (excluding never users of other products) in the 26+ age 
group (N=334) 

Question: Q.1.1. Have you ever used HTPs? 

Note: The diagram is a simplified version of the career flows of dual HTP users, i.e. it highlights dual 
use patterns as well as transitions to/from other products; therefore, never users of other products 
were  excluded.  The  thickness/width  of  the  tails,  as  well  as  the  percentages  included,  are  only 
indicative. Some individuals may be represented twice (or more) if they use/have used more than 
one product at a time.  

Source: OE elaboration from online survey data152 

152 The diagram was developed using the Sankey Diagram Generator online tool.  
http://sankey-diagram-generator.acquireprocure.com 

279 

 
  
 
 
                                           
Consumer preference and perception of specific categories of tobacco and related products 

Table 77. Perceived gateway effect of product (HTPs; 18-25 age group)  

(% (number)- of 18-25 age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(6090) 

22 

(1313) 

44 

(2703) 

16 

(966) 

7 

(425) 

11 

(683) 

Current 
users 

Past users 

% 

Used once 
or twice 

Never 
used 

% 

8 

15 

7 

8 

6 

3 

7 

9 

8 

7 

5 

2 

% 

16 

16 

17 

18 

12 

9 

% 

69 

60 

68 

67 

77 

86 

Base: respondents in the 18-25 age group (N=6,090) 
Question:  Q4.3.  Do  you  think  using  heated  tobacco  products  (e.g.  iQOS,  glo)  might  encourage 
people to start smoking/using other tobacco products, or not? [SINGLE ANSWER] 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total category refers to the total respondents in the 18-25 age group. 
Source: OE elaboration from online survey data 

280 

 
 
 
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Table 78. Perceived gateway effect of product (HTPs; 26+ age group) 

(% (number) - of respondents in the 26+ age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total  

%(n) 

100  

(5,910) 

19 

 (1114) 

41 

(2429) 

15 

(910) 

8 

(466) 

17 

(991) 

Current users 

% 

11 

19 

12 

10 

4 

3 

Past 
users 

Used once 
or twice 

Never 
used 

% 

6 

6 

8 

4 

4 

2 

% 

10 

11 

12 

11 

10 

4 

% 

73 

64 

69 

74 

82 

90 

Base: respondents in the 26+ age group (N=5,910) 
Question:  Question:  Q4.3.  Do  you  think  using  heated  tobacco  products  (e.g.  iQOS,  glo)  might 
encourage people to start smoking/using other tobacco products, or not? [SINGLE ANSWER] 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total category refers to the total respondents in the 26+ age group. 
Source: OE elaboration from online survey data 

Table 79. Perceived appeal of product to youth (HTPs; 18-25 age group)  

(% (number) - of respondents in the 18-25 age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total  

%(n) 

100 

(6090) 

28 

(1712) 

42 

(2535) 

16 

(969) 

6 

(356) 

9 

(518) 

Current 
users 

% 

8 

11 

8 

6 

12 

3 

Past users 

% 

7 

9 

7 

8 

10 

3 

Used once 
or twice 

Never 
used 

% 

16 

19 

16 

14 

13 

9 

% 

69 

61 

70 

72 

65 

84 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.5. Do you think that young people might be particularly attracted to heated tobacco 
products (e.g. iQOS, glo), or not? [SINGLE ANSWER] 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 

281 

 
 
Consumer preference and perception of specific categories of tobacco and related products 

for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total category refers to the total respondents in the 18-25 age group. 
Source: OE elaboration from online survey data 

Table 80. Perceived appeal of product to youth (HTPs; 26+ age group)  

(% (number) - of respondents in the 26+ age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total  

%(n) 

100 

(5910) 

21 

(1252) 

45 

(2679) 

15 

(859) 

5 

(288) 

14 

(832) 

Current 
users 

Past users 

% 

Used once 
or twice 

Never 
used 

% 

11 

18 

12 

6 

7 

3 

6 

7 

6 

6 

5 

2 

% 

10 

13 

11 

10 

10 

4 

% 

73 

62 

71 

78 

79 

92 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.5. Do you think that young people might be particularly attracted to heated tobacco 
products (e.g. iQOS, glo), or not? [SINGLE ANSWER] 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total column refers to the total respondents in the 26+ age group. 
Source: OE elaboration from online survey data 

Table 81. Extent to which respondents believed that youth underestimated risks of using HTPs 

(% (number)- of 18-25 age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(6090) 

42 

(2556) 

35 

(2134) 

13 

(765) 

5 

(309) 

5 

(326) 

Current 
users 

% 

8 

7 

9 

10 

12 

8 

Past users 

% 

7 

6 

8 

11 

7 

4 

Used once 
or twice 

Never 
used 

% 

16 

15 

16 

18 

19 

10 

% 

69 

72 

67 

62 

61 

78 

Base: respondents in the 18-25 age group (N=6,090) 

282 

 
 
Consumer preference and perception of specific categories of tobacco and related products 

Question: Q.4.6. Do you think that young people might underestimate the risk of consuming heated 
tobacco products (e.g. iQOS, glo), or not? [SINGLE ANSWER]  
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total category refers to the total respondents in the 18-25 age group. 
Source: OE elaboration from online survey data 

Table 82. Extent to which respondents believed that youth underestimate risks of HTPs 

(% (number) - of respondents in the 26+ age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(5910) 

36 

(2149) 

40 

(2378) 

11 

(663) 

5 

(271) 

8 

(449) 

Current 
users 

Past users 

% 

Used once 
or twice 

Never 
used 

% 

11 

9 

13 

13 

6 

5 

6 

5 

7 

8 

4 

3 

% 

10 

9 

11 

11 

10 

7 

% 

73 

76 

69 

69 

81 

85 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.6. Do you think that young people might underestimate the risk of consuming heated 
tobacco products (e.g. iQOS, glo), or not? [SINGLE ANSWER]  
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response in particular (i.e. the sum of the white cells in each row should add up to 100). 
The group total category refers to the total respondents in the 26+ age group. 
Source: OE elaboration from online survey data 

Table 83. Extent of agreement with regulating the product like cigarettes (HTPs; 18-25 age 
group)  

(% - of respondents in the 18-25 age group) 

Answer 

Group 
total  

Current 
users 

Past users  Used once 

or twice 

Never 
used 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

100 

(6090) 

44 

(2662) 

30 

(1825) 

12 

(716) 

6 

(351) 

8 

6 

10 

12 

15 

7 

5 

8 

11 

13 

16 

69 

15 

16 

21 

16 

74 

65 

56 

57 

283 

 
 
Consumer preference and perception of specific categories of tobacco and related products 

I don’t know 

9 

(536) 

5 

4 

27 

79 

Base: respondents in the 18-25 age group (N=6,090) 
Question: Q.4.7. Do you think that heated tobacco products should be regulated like cigarettes, or 
not? [SINGLE ANSWER] 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response (i.e. the sum of the white cells in each row should add up to 100). The group total 
category refers to the total respondents in the 18-25 age group. 
Source: OE elaboration from online survey data 

Table 84. Extent of agreement with regulating the product like cigarettes (HTPs; 26+ age 
group)  

(% - of respondents in the 26+ age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total  

100 

(5910) 

48 

(2824) 

31 

(1836) 

9 

(506) 

5 

(288) 

8 

(456) 

Current 
users 

Past users  Used once 

or twice 

Never 
used 

11 

8 

15 

14 

15 

6 

6 

4 

8 

10 

7 

4 

10 

73 

9 

11 

15 

12 

5 

79 

67 

60 

65 

85 

Base: respondents in the 26+ age group (N=5,910) 
Question: Q.4.7. Do you think that heated tobacco products should be regulated like cigarettes, or 
not? [SINGLE ANSWER] 
Note: The orange column represents the share of respondents in the age group that selected the 
response. The white cells in the four columns on the right represent the breakdown by type of users 
for that response (i.e. the sum of the white cells in each row should add up to 100). The group total 
category refers to the total respondents in the 26+ age group. 
Source: OE elaboration from online survey data 

284 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

10.5 Electronic cigarettes 

Table 85. Perceived gateway effect of product (e-cigarettes; 18-25 age group)  

(% (number) - of respondents in the 18-25 age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(6090) 

31 

(1918) 

40 

(2427) 

16 

(952) 

6 

(339) 

7 

(454) 

Current 
users 

% 

15 

16 

15 

14 

18 

11 

Past users 

% 

15 

16 

15 

17 

16 

9 

Used once 
or twice 

Never 
used 

% 

25 

24 

27 

27 

22 

19 

% 

45 

44 

43 

42 

44 

61 

Base: respondents in the 18-25 age group (N=6,090) 

Question: Q.4.9. Do you think that vaping electronic cigarettes might encourage people 
to start smoking/using other tobacco products, or not?  

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 18-25 age group. 

Source: OE elaboration from online survey data 

Table 86. Perceived gateway effect of product (e-cigarettes; 26+ age group) 

(% (number) - of respondents in the 26+ age group) 

Answer 

Group 
total % 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

%(n) 

100 

(5910) 

25 

(1503) 

42 

(2513) 

16 

(922) 

6 

(330) 

Current users 

% 

18 

18 

18 

20 

22 

Past 
users 

Used once 
or twice 

Never 
used 

% 

11 

11 

11 

12 

10 

% 

16 

15 

17 

19 

10 

% 

56 

56 

54 

49 

58 

285 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

I don’t know 

11 

(642) 

9 

8 

10 

73 

Base: respondents in the 26+ age group (N=5,910) 

Question: Q.4.9. Do you think that vaping electronic cigarettes might encourage people 
to start smoking/using other tobacco products, or not?  

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 26+ age group. 
Source: OE elaboration from online survey data 

Table 87. Perceived appeal of product to youth (e-cigarettes; 18-25 age group)  

(% (number) - of respondents in the 18-25 age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(6090) 

46 

(2775) 

34 

(2053) 

10 

(625) 

5 

(301) 

6 

(336) 

Current 
users 

% 

15 

16 

15 

18 

18 

14 

Past users 

% 

15 

14 

15 

18 

22 

10 

Used once 
or twice 

Never 
used 

% 

25 

29 

24 

23 

18 

15 

% 

45 

42 

46 

41 

42 

61 

Base: respondents in the 18-25 age group (N=6,090) 

Question:  Question:  Q.4.11.  Do  you  think  that  young  people  might  be  particularly 
attracted to electronic cigarettes (vaping), or not? 

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 18-25 age group. 

Source: OE elaboration from online survey data 

286 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 88. Perceived appeal of product to youth (e-cigarettes; 26+ age group)  

(% (number) - of respondents in the 26+ age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(5910) 

32 

(1883) 

44 

(2573) 

12 

(706) 

4 

(237) 

9 

(511) 

Current 
users 

% 

18 

20 

19 

16 

14 

9 

Past users 

% 

11 

11 

10 

16 

13 

6 

Used once 
or twice 

Never 
used 

% 

16 

16 

16 

17 

11 

12 

% 

56 

54 

55 

51 

62 

73 

Base: respondents in the 26+ age group (N=5,910) 

Question: Q.4.11. Do you think that young people might be particularly attracted to 
electronic cigarettes (vaping), or not? 

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells  in  each  row  should  add  up  to  100).  The  group  total  column  refers  to  the  total 
respondents in the 26+ age group. 

Source: OE elaboration from online survey data 

287 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 89. Extent to which respondents believed that youth underestimate risks of using e-
cigarettes  

(% (number) - of respondents in the 18-25 age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(6090) 

45 

(2712) 

31 

(1882) 

13 

(806) 

6 

(367) 

5 

(323) 

Current 
users 

% 

15 

12 

18 

18 

17 

14 

Past users 

% 

15 

13 

16 

21 

14 

11 

Used once 
or twice 

Never 
used 

% 

25 

27 

24 

25 

30 

17 

% 

45 

48 

42 

36 

38 

59 

Base: respondents in the 18-25 age group (N=6,090) 

Question:  Q.4.12.  Do  you  think  that  young  people  might  underestimate  the  risk  of 
using electronic cigarettes (vaping), or not? 

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 18-25 age group. 

Source: OE elaboration from online survey data 

Table 90. Extent to which respondents believed that youth underestimated risks of using e-
cigarettes 

(% (number) - of respondents in the 26+ age group) 

Answer 

Use of product 

Definitely yes 

Probably yes 

Probably not 

Definitely not 

I don’t know 

Group 
total 

%(n)  

100 

(5910) 

40 

(2360) 

37 

(2179) 

11 

(678) 

5 

(323) 

6 

Current 
users 

% 

18 

14 

22 

20 

15 

15 

Past users 

% 

11 

9 

12 

14 

10 

7 

Used once 
or twice 

Never 
used 

% 

16 

15 

17 

16 

18 

11 

% 

56 

62 

50 

49 

56 

68 

288 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

(370) 

Base: respondents in the 26+ age group (N=5,910) 

Question:  Q.4.12.  Do  you  think  that  young  people  might  underestimate  the  risk  of 
using electronic cigarettes (vaping), or not? 

Note: The orange column represents the share of respondents in the age group that 
selected the response. The white cells in the four columns on the right represent the 
breakdown by type of users for that response in particular (i.e. the sum of the white 
cells in each row should add up to 100). The group total category refers to the total 
respondents in the 26+ age group. 

Source: OE elaboration from online survey data 

10.6 Comparative Analysis 

Figure 200. Education level of product consumers by product: 18-25 age group  

Source: OE elaboration from study data 

289 

 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 201. Education level of product consumers by product: 26+ age group  

Source: OE elaboration from study data 

290 

 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 202. Place of residency of consumers by product: 18-25 age group 

Source: OE elaboration from study data 

Figure 203. Place of residency of consumers by product: 26+ age group 

Source: OE elaboration from study data 

291 

 
 
 
 
 
 
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Figure 204. Self-reported economic status by product: 18-25 age group 

Source: OE elaboration from study data 

Figure 205. Self-reported economic status by product: 26+ age group 

Source: OE elaboration from study data 

292 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

Table 91. Regulating like cigarettes v. harm to passive users  

Regulation for electronic cigarettes 
(1- Definitely not, 2- Probably not, 3- 
Probably yes, 4- Definitely yes) 

Regulation for HTPs 
(1- Definitely not, 2- Probably not, 3- 
Probably yes, 4- Definitely yes) 

Predictors 

Estimates 

CI 

p 

Estimates 

CI 

p 

Harmfulness for 
others (scores 0-
100) 

Dummy  user  (1-
user) 

Gender 

Age 

Education level 

0.00 

0.00 – 0.01 

<0.001 

0.00 

0.00 – 0.00 

<0.001 

-0.35 

-0.40 – -0.31  <0.001 

-0.17 

-0.23 – 0.12 

<0.001 

0.12 

0.01 

0.04 

0.09 – 0.16 

<0.001 

0.01 – 0.01 

<0.001 

0.02 – 0.05 

<0.001 

0.13 

0.01 

0.02 

0.10 – 0.16 

<0.001 

0.00 – 0.01 

<0.001 

0.01 – 0.03 

<0.001 

Residency 

-0.00 

-0.02 – 0.02 

0.975 

-0.01 

-0.03 – 0.01 

0.282 

Employment 
status 

Socio-economic 
status 

0.00 

-0.01 – 0.01 

0.741 

0.01 

0.01 – 0.02 

0.001 

0.00 

-0.01 – 0.01 

0.700 

-0.00 

-0.01 – 0.01 

0.518 

(Intercept) 

2.40 

2.27 – 2.53 

<0.001 

2.18 

2.01 – 2.34 

<0.001 

Observations 

11176 

R2 / R2 adjusted 

0.076 / 0.075 

11007 

0.046 / 0.045 

Regulation for electronic cigarettes 
(1- Definitely not, 2- Probably not, 3- 
Probably yes, 4- Definitely yes) 

Regulation for HTPs 
(1- Definitely not, 2- Probably not, 3- 
Probably yes, 4- Definitely yes) 

Predictors 

Estimates 

CI 

p 

Estimates 

CI 

p 

Harmfulness for 
others (scores 
0-100) 

Dummy user (1-
user) 

Gender 

Age 

Education level 

0.00 

0.00 – 0.01 

<0.001 

0.00 

0.00 – 0.00 

<0.001 

-0.35 

-0.40 – -0.31 

<0.001 

-0.17 

-0.23 – 0.12 

<0.001 

0.12 

0.01 

0.04 

0.09 – 0.16 

<0.001 

0.01 – 0.01 

<0.001 

0.02 – 0.05 

<0.001 

0.13 

0.01 

0.02 

0.10 – 0.16 

<0.001 

0.00 – 0.01 

<0.001 

0.01 – 0.03 

<0.001 

Residency 

-0.00 

-0.02 – 0.02 

0.975 

-0.01 

-0.03 – 0.01 

0.282 

Employment 
status 

Socio-economic 
status 

0.00 

-0.01 – 0.01 

0.741 

0.01 

0.01 – 0.02 

0.001 

0.00 

-0.01 – 0.01 

0.700 

-0.00 

-0.01 – 0.01 

0.518 

(Intercept) 

2.40 

2.27 – 2.53 

<0.001 

2.18 

2.01 – 2.34 

<0.001 

Observations 

11176 

R2 / R2 adjusted  0.076 / 0.075 

11007 

0.046 / 0.045 

Base: all respondents in the online survey (N=12,000) 
Note: *** refers to the 0.01 level, ** refers to the 0.05 level & * refers to the 0.1 level, the latter 
not being considered as significant for the purpose of this study.  
Source: OE elaboration from online survey data 

293 

 
 
 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

11  List of figures 

Figure 1. Scope of the study ......................................................................................... 18 

Figure 2. Overall approach ............................................................................................ 19 

Figure 3. Market size of waterpipe & pipe tobacco products in million EUR in 2017 ............... 31 

Figure 4. Price of waterpipe and pipe tobacco products across EU in 2017, euros per kg ....... 32 

Figure 5. Market size trends of waterpipe & pipe tobacco products: 2012-2017 ................... 33 

Figure 6. Use of waterpipe: country breakdown (18-25 age group) .................................... 35 

Figure 7. Use of waterpipe: country breakdown (26+ age group) ...................................... 36 

Figure 8. Frequency of use of current waterpipe users (18-25 age group) ........................... 39 

Figure 9. Frequency of use of current waterpipe users (26+ age group) ............................. 39 

Figure 10. Frequency of use of past waterpipe users (18-25 age group) ............................. 40 

Figure 11. Frequency of use of past waterpipe users (26+ age group)................................ 40 

Figure 12. Average number of minutes per day of waterpipe use (18-25 age group) ............ 41 

Figure 13. Average number of minutes per day of waterpipe use (26+ age group) .............. 41 

Figure 14. Average number of minutes per day for daily waterpipe users (18-25 age group). 42 

Figure 15. Average number of minutes per day, for daily waterpipe users (26+ age group) .. 42 

Figure 16. Initiation of use for current and past users (waterpipe; total sample) ................. 43 

Figure 17. Cessation: attempts to quit waterpipe (18-25 age group) .................................. 45 

Figure 18. Cessation: attempts to quit waterpipe (26+ age group) .................................... 45 

Figure 19. Cessation: reasons for trying to quit waterpipe use (18-25 age group)................ 46 

Figure 20. Cessation: reasons for trying to quit waterpipe use (26+ age group) .................. 46 

Figure 21. Reasons for starting to use waterpipe again (18-25 age group) .......................... 47 

Figure 22. Reasons for starting to use waterpipe again (26+ age group) ............................ 47 

Figure 23. Perceived appeal of waterpipe to youth (waterpipe; 18-25 age group) ................ 54 

Figure 24. Perceived appeal of waterpipe to youth (waterpipe; 26+ age group) ................... 54 

Figure  25.  Extent  to  which  respondents  believed  that  youth  underestimate  risks  of  using 
waterpipe tobacco (18-25 age group) ...................................................................... 55 

Figure  26.  Extent  to  which  respondents  believed  that  youth  underestimate  risks  of  using 
waterpipe tobacco (26+ age group) ......................................................................... 56 

Figure 27. Perceived harmfulness of waterpipe tobacco to users (18-25 age group) ............. 57 

Figure 28. Perceived harmfulness of waterpipe to users (26+ age group) ........................... 58 

Figure 29. Perceived harmfulness of waterpipe to bystanders (18-25 age group) ................. 59 

Figure 30. Perceived harmfulness of waterpipe to bystanders (26+group) .......................... 60 

Figure 31. Market size of slim cigarettes in million units in 2017 ........................................ 65 

Figure 32. Share of slim cigarettes within the national total tobacco market, per country (2017)
 ........................................................................................................................... 66 

294 

 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 33. Market size growth of slim cigarettes, in retail volume in 2017 as a baseline of 2012
 ........................................................................................................................... 66 

Figure 34. Share of slim cigarettes in total market of cigarettes, in retail volume: 2012-2017 67 

Figure 35. Use of slim cigarettes: country breakdown (18-25 age group) ........................... 70 

Figure 36. Use of slim cigarettes: country breakdown (26+ age group) .............................. 71 

Figure 37. Frequency of use of current slim cigarette users (18-25 age group) .................... 74 

Figure 38. Frequency of use of current slim cigarette users (26+ age group) ...................... 74 

Figure 39. Frequency of use of past slim cigarette users (18-25 age group) ........................ 75 

Figure 40. Frequency of use of past slim cigarette users (26+ age group) .......................... 75 

Figure 41. Average number of slim cigarettes per day of use (18-25 age group) ................. 76 

Figure 42 Average number of slim cigarettes per day of use (26+ age group) ..................... 76 

Figure 43. Initiation of use for current and past users (slim cigarettes; total sample) ........... 77 

Figure 44. Duration of use of past slim cigarette users (18-25 age group) .......................... 78 

Figure 45. Duration of use of past slim cigarette users (26+ age group) ............................. 78 

Figure 46. Reasons for initiation of slim cigarette use (18-25 age group) ............................ 79 

Figure 47. Reasons for initiation of slim cigarette use ( 26+ age group) ............................. 79 

Figure 48. Initiation of slim cigarette use: reasons for trying (18-25 age group) .................. 80 

Figure 49. Initiation of slim cigarette use: reasons for trying (26+ age group) .................... 80 

Figure 50. Reasons for trying to quit slim cigarette use (18-25 age group) ......................... 81 

Figure 51. Reasons for trying to quit slim cigarette use (26+ age group) ............................ 81 

Figure 52. Reasons for starting to use slim cigarettes again (18-25 age group) ................... 82 

Figure 53. Reasons for starting to use slim cigarettes again (26+ age group) ...................... 82 

Figure 54. Perceived harmfulness of slim cigarettes to users (18-25 age group) .................. 89 

Figure 55. Perceived harmfulness of slim cigarettes to users (26+ age group) .................... 90 

Figure 56. Perceived harmfulness of slim cigarettes to bystanders (18-25 age group) .......... 91 

Figure 57. Perceived harmfulness of slim cigarettes to bystanders (26+ group) ................... 92 

Figure 58. Market size of small cigarillos in million euro in 2017 ........................................ 97 

Figure 59. Share of small cigarillos within the national total tobacco market, per country (2017)
 ........................................................................................................................... 98 

Figure 60. Price of small cigarillos in 2017, euros per unit (stick) ....................................... 98 

Figure 61. Market size trends of small cigarillos over 2012-2017 ....................................... 99 

Figure 62. Use of small cigarillos: country breakdown (18-25 age group) .......................... 100 

Figure 63. Use of small cigarillos: country breakdown (26+ age group) ............................. 101 

Figure 64. Frequency of use of current small cigarillo users (18-25 age group)................... 104 

Figure 65. Frequency of use of current small cigarillo users ( 26+ age group) .................... 104 

Figure 66. Frequency of use of past small cigarillo users (18-25 age group) ....................... 105 

295 

 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 67 Frequency of use of past small cigarillo users (26+ age group) .......................... 105 

Figure 68. Average number of small cigarillo sticks per day of use (18-25 age group) ......... 106 

Figure 69. Average number of small cigarillo sticks per day of use (26+ age group) ........... 106 

Figure 70. Average number of small cigarillo sticks per day, for daily users (18-25 age group)
 .......................................................................................................................... 107 

Figure  71.  Average  number  of  small  cigarillo  sticks  per  day,  for  daily  users  (26+  age  group)
 .......................................................................................................................... 107 

Figure 72. Initiation of use for current and past small cigarillo users (total sample) ............ 108 

Figure 73. Duration of use of past small cigarillo users (18-25 age group) ......................... 109 

Figure 74. Duration of use of past small cigarillo users (26+ age group) ............................ 109 

Figure 75. Initiation of small cigarillo use: reasons (18-25 age group)............................... 110 

Figure 76. Initiation of small cigarillo use: reasons (26+ age group) ................................. 110 

Figure 77. Initiation of small cigarillo use: reasons for trying small cigarillos (18-25 age group)
 .......................................................................................................................... 111 

Figure 78.  Initiation of small cigarillo use: reasons for trying small cigarillos (26+ age group)
 .......................................................................................................................... 111 

Figure 79. Cessation: attempts to quit small cigarillos (18-25 age group) .......................... 112 

Figure 80. Cessation: attempts to quit small cigarillos (26+ age group) ............................ 112 

Figure 81. Cessation: reasons for trying to quit small cigarillos (18-25 age group) .............. 113 

Figure 82. Cessation: reasons for trying to quit small cigarillos (26+ age group) ................ 113 

Figure 83. Reasons for starting to use small cigarillos again (18-25 age group) .................. 114 

Figure 84. Reasons for starting to use small cigarillos again (26+ age group) .................... 114 

Figure  85.  Representation  of  career  flows  for  current  small  cigarillo  users  (18-25  age  group)
 .......................................................................................................................... 117 

Figure 86. Representation of career flows for current small cigarillo users (26+ age group) . 117 

Figure 87. Representation of career flows for past small cigarillo users (18-25 age group) ... 120 

Figure 88. Representation of career flows for past small cigarillo users (26+ age group) ..... 120 

Figure 89. Perceived harmfulness of small cigarillos to users (18-25 age group) ................. 124 

Figure 90. Perceived harmfulness of small cigarillos to users (26+ age group) ................... 125 

Figure 91. Perceived harmfulness of small cigarillos to bystanders (18-25 age group) ......... 126 

Figure 92. Perceived harmfulness of small cigarillos to bystanders (26+ age group) ........... 127 

Figure 93. Market size of heated tobacco products (HTPs) in million euros in 2017 ............. 131 

Figure 94. Share of HTPs within the national total tobacco market, per country (2017) ....... 132 

Figure 95. Use of HTPs: country breakdown (18-25 age group) ........................................ 135 

Figure 96. Use of HTPs: country breakdown (26+ age group) .......................................... 136 

Figure 97. Frequency of use of current HTP users (18-25 age group) ................................ 139 

296 

 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 98. Frequency of use of current HTP users (26+ age group) ................................... 139 

Figure 99. Frequency of use of past HTP users (18-25 age group) .................................... 140 

Figure 100. Frequency of use of past HTP users (26+ age group) ..................................... 140 

Figure 101. Average number of HTP sticks a day for current users (18-25 age group) ......... 141 

Figure 102. Average number of HTP sticks a day for current users (26+ age group) ........... 141 

Figure 103. Average number of HTP sticks a day, for daily users (18-25 age group) ........... 142 

Figure 104. Average number of HTP sticks a day, for daily users (26+ age group) .............. 142 

Figure 105. Initiation of HTP use: reasons (18-25 age group) .......................................... 143 

Figure 106. Initiation of HTP use: reasons (26+ age group) ............................................. 143 

Figure 107. Initiation of HTP use: reasons for trying (18-25 age group) ............................ 144 

Figure 108. Initiation of HTP use: reasons for trying (26+ age group) ............................... 145 

Figure 109. Cessation: attempts to quit HTPs (18-25 age group) ...................................... 146 

Figure 110. Cessation: attempts to quit HTPs (26+ age group) ........................................ 146 

Figure 111. Cessation: reasons for trying to quit HTP use (18-25 age group) ..................... 147 

Figure 112. Cessation: reasons for trying to quit HTP use (26+ age group)........................ 147 

Figure 113. Reasons for starting to use HTPs again (18-25 age group) .............................. 148 

Figure 114. Reasons for starting to use HTPs again (26+ age group) ................................ 148 

Figure 115. Perceived gateway effect of HTPs (18-25 age group) ..................................... 158 

Figure 116 Perceived gateway effect of HTPs (26+ age group) ......................................... 158 

Figure 117 Perceived appeal of HTPs to youth (18-25 age group) ..................................... 159 

Figure 118 Perceived appeal of HTPs to youth (26+ age group) ........................................ 159 

Figure 119 Extent to which respondents believed that youth underestimated risks of using HTPs
 .......................................................................................................................... 160 

Figure 120 Extent to which respondents believed that youth underestimate risks of HTPs .... 161 

Figure 121. Perceived harmfulness of HTPs to users (18-25 age group) ............................. 163 

Figure 122. Perceived harmfulness of HTPs to users (26+ age group) ............................... 164 

Figure 123. Perceived harmfulness of HTPs to bystanders (18-25 age group) ..................... 165 

Figure 124. Perceived harmfulness of HTPs to bystanders (26+group) .............................. 166 

Figure 125. Extent of agreement with regulating HTPs like cigarettes (18-25 age group) ..... 167 

Figure 126. Extent of agreement with regulating HTPs like cigarettes (26+ age group) ....... 167 

Figure 127. Market size of electronic cigarettes in million euros in 2017 ............................ 174 

Figure 128. Share of electronic cigarettes within the national total tobacco market, per country 
(2017) ................................................................................................................ 175 

Figure 129 Price dynamics of electronic cigarettes (in retail selling prices, RSP): 2012-2017 176 

Figure 130. Use of e-cigarettes: country breakdown (18-25 age group) ............................ 184 

Figure 131. Use of e-cigarettes: country breakdown (26+ age group) ............................... 185 

297 

 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 132. Frequency of use of current e-cigarette users (18-25 age group) ..................... 188 

Figure 133. Frequency of use of current e-cigarette users (26+ age group) ....................... 188 

Figure 134. Frequency of use of past e-cigarette users (18-25 age group) ......................... 189 

Figure 135. Frequency of use of past e-cigarette users (26+ age group) ........................... 189 

Figure 136. Average number of puffs per session (18-25 age group)................................. 190 

Figure 137. Average number of puffs per session (26+ age group) ................................... 190 

Figure 138. Average number of sessions per day of use (18-25 age group) ....................... 191 

Figure 139. Average number of sessions per day (26+ age group) ................................... 191 

Figure 140. Number of sessions per day, for daily users (18-25 age group) ....................... 192 

Figure 141. Number of sessions per day, for daily users (26+ age group) .......................... 192 

Figure 142. Initiation of use for current and past e-cigarette users (total sample)............... 193 

Figure 143. Duration of use of past e-cigarette users (18-25 age group) ........................... 194 

Figure 144. Duration of use of past e-cigarette users (26+ age group) .............................. 194 

Figure 145. Initiation of e-cigarette use: reasons (18-25 age group) ................................. 195 

Figure 146. Initiation of e-cigarette use: reasons (26+ age group) ................................... 195 

Figure 147. Initiation of e-cigarette use: reasons (18-25 age group) ................................. 196 

Figure 148. Initiation of e-cigarette use: reasons (26+ age group) ................................... 197 

Figure 149. Cessation: attempts to quit e-cigarettes (18-25 age group) ............................ 197 

Figure 150. Cessation: attempts to quit e-cigarettes (26+ age group)............................... 198 

Figure 151. Cessation: reasons for trying to quit e-cigarette use (18-25 age group) ........... 198 

Figure 152. Cessation: reasons for trying to quit e-cigarette use (26+ age group) .............. 199 

Figure 153. Reasons for starting to use e-cigarettes again (18-25 age group) .................... 199 

Figure 154. Reasons for starting to use e-cigarettes again (26+ age group) ...................... 200 

Figure 155. Representation of career flows for current e-cigarette users (18-25 age group) . 203 

Figure 156. Representation of career flows for current e-cigarette users (26+ age group) ... 203 

Figure 157. Representation of career flows for past e-cigarette users (18-25 age group) ..... 206 

Figure 158. Representation of career flows for past e-cigarette users (26+ age group) ....... 206 

Figure 159. Perceived gateway effect of e-cigarettes (18-25 age group) ............................ 209 

Figure 160. Perceived gateway effect of e-cigarettes (26+ age group) .............................. 210 

Figure 161. Perceived appeal of e-cigarettes to youth (18-25 age group) .......................... 210 

Figure 162. Perceived appeal of e-cigarettes to youth (26+ age group) ............................. 211 

Figure  163  Extent  to  which  respondents  believed  that  youth  underestimate  risks  of  using  e-
cigarettes ............................................................................................................ 211 

Figure 164  Extent to which respondents believed that  youth underestimated  risks  of using  e-
cigarettes ............................................................................................................ 212 

Figure 165. Perceived harmfulness of e-cigarettes to users (18-25 age group) ................... 213 

298 

 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 166. Perceived harmfulness of e-cigarettes to users (26+ age group) ..................... 214 

Figure 167. Perceived harmfulness of e-cigarettes to bystanders(18-25 age group) ............ 215 

Figure 168. Perceived harmfulness of e-cigarettes to bystanders(26+group) ...................... 216 

Figure 169 Share of smokers by countries ..................................................................... 224 

Figure 170. Overview of the consumption of the five products (18-25 age group) ............... 226 

Figure 171. Overview of the consumption of the five products (26+ age group) ................. 227 

Figure 172. Gender of consumers by product: 18+25 age group ...................................... 228 

Figure 173. Gender of consumers by product: 26+ age group .......................................... 228 

Figure 174. VAT values on tobacco products by countries in 2017 ..................................... 233 

Figure 175 Taxes on tobacco products by countries in 2017 ............................................. 235 

Figure 176. Duration of use of past users (waterpipe; 18-25 age group) ........................... 257 

Figure 177. Duration of use of past users (waterpipe; 26+ age group) .............................. 257 

Figure 178. Initiation of waterpipe use: reasons (18-25 age group) .................................. 258 

Figure 179. Initiation of waterpipe use: reasons (26+ age group) ..................................... 259 

Figure 180. Initiation of waterpipe use: reasons for trying (waterpipe; 18-25 age group) .... 260 

Figure 181. Initiation of waterpipe use: reasons for trying (waterpipe; 26+ age group) ....... 261 

Figure  182.  Representation  of  career  flows  for  current  user  (waterpipe  tobacco;  18-25  age 
group) ................................................................................................................ 262 

Figure 183. Representation of career flows for current user (waterpipe tobacco; 26+ age group)
 .......................................................................................................................... 263 

Figure 184 Representation of career flows for past user (waterpipe tobacco; 18-25 age group)
 .......................................................................................................................... 264 

Figure  185  Representation  of  career  flows  for  past  user  (waterpipe  tobacco;  26+  age  group)
 .......................................................................................................................... 265 

Figure  186.  Average  number  of  slim  cigarette  sticks  per  day  of  use,  daily  users  (18-25  age 
group) ................................................................................................................ 268 

Figure 187. Average number of slim cigarettes sticks per day, for daily users (26+ age group)
 .......................................................................................................................... 269 

Figure 188. Cessation: slim cigarettes quit attempts (slim cigarettes; 18-25 age group) ..... 270 

Figure 189. Cessation: slim cigarettes quit attempts (slim cigarettes; 26+ age group) ........ 270 

Figure 190. Representation of career flows for current users (slim cigarettes; 18-25 age group)
 .......................................................................................................................... 271 

Figure 191. Representation of career flows for  current users (slim cigarettes; 26+ age group)
 .......................................................................................................................... 272 

Figure  192.  Representation  of  career  flows  for  past  users  (slim  cigarettes;  18-25  age  group)
 .......................................................................................................................... 273 

Figure 193. Representation of career flows for past users (slim cigarettes; 26+ age group) . 274 

Figure 194. Duration of use of past users (HTPs; 18-25 age group) .................................. 275 

299 

 
Consumer preference and perception of specific categories of tobacco and related products 

Figure 195. Duration of use of past users (HTPs; 26+ age group) ..................................... 275 

Figure 196. Representation of career flows for current users (HTPs; 18-25 age group) ........ 276 

Figure 197. Representation of career flows for current users (HTPs; 26+ age group) .......... 277 

Figure 198. Representation of career flows for past users (HTPs; 18-25 age group) ............ 278 

Figure 199. Representation of career flows for past users (HTPs; 26+ age group) .............. 279 

Figure 200. Education level of product consumers by product: 18-25 age group ................. 289 

Figure 201. Education level of product consumers by product: 26+ age group ................... 290 

Figure 202. Place of residency of consumers by product: 18-25 age group ........................ 291 

Figure 203. Place of residency of consumers by product: 26+ age group ........................... 291 

Figure 204. Self-reported economic status by product: 18-25 age group ........................... 292 

Figure 205. Self-reported economic status by product: 26+ age group .............................. 292 

300 

 
 
 
 
Consumer preference and perception of specific categories of tobacco and related products 

12  List of tables 

Table 1. Current Consumption by product and by Member State ........................................ 16 

Table 2. Mixed methods approach ................................................................................. 20 

Table 3. Literature review information found by product ................................................... 21 

Table 4. Results by tobacco product category .................................................................. 22 

Table 5. Quantitative information found by product.......................................................... 22 

Table 6. Summary of the main information gaps ............................................................. 23 

Table 7. Focus groups geographical scope ...................................................................... 24 

Table 8. Data gaps addressed by the focus group ............................................................ 24 

Table 9. Online survey: Geographic scope and quota breakdown by country (N=12,000) ..... 25 

Table 10. Data gaps addressed by the Online survey ....................................................... 26 

Table 11. Mapping of survey questionnaire by research question ....................................... 27 

Table 12. Socio-demographic breakdown of online survey (18-25 age group) ..................... 28 

Table 13. Socio-demographic breakdown of online survey (26+ age group) ........................ 29 

Table 14. Waterpipe use socio-demographic breakdown (18-25 age group) ........................ 37 

Table 15. Waterpipe use socio-demographic breakdown (26+ age group) ........................... 38 

Table 16. Reasons for starting to use or trying waterpipe (18-25 age group) ...................... 44 

Table 17. Reasons for starting to use or trying waterpipe (26+ age group) ......................... 44 

Table 18. Career flows of use for current waterpipe users (18-25 age group) ...................... 48 

Table 19. Career flows of current waterpipe users (26+ age group) ................................... 49 

Table 20. Career flow of past waterpipe users (18-25 age group) ...................................... 50 

Table 21. Career flows of past waterpipe users (26+ age group) ....................................... 51 

Table 22. Perception of waterpipe tobacco (18-25 age group) ........................................... 52 

Table 23. Perception of waterpipe tobacco; 26+ age group) .............................................. 53 

Table  24.  “Which  of  the  following  statements,  if  any,  do  you  think  apply  to  slim  cigarettes?” 
(2017) ................................................................................................................. 69 

Table 25. Slim cigarette use socio-demographic breakdown (18-25 age group) ................... 72 

Table 26. Slim cigarette use socio-demographic breakdown (26+ age group) ..................... 73 

Table 27. Career flows of slim cigarette use for current users (18-25 age group) ................. 83 

Table 28. Career flows of current slim cigarette users (26+ age group) .............................. 84 

Table 29 Career flow of past slim cigarette users (18-25 age group) .................................. 85 

Table 30 Career flows of past slim cigarette users (26+ age group) ................................... 86 

Table 31. Tax provisions applicable to manufactured tobacco ............................................ 94 

Table 32. Small cigarillo use socio-demographic breakdown (18-25 age group) .................. 102 

Table 33. Small cigarillo use socio-demographic breakdown (26+ age group) .................... 103 

301 

 
Consumer preference and perception of specific categories of tobacco and related products 

Table 34. Career flows of small cigarillo use for current users (18-25 age group)................ 115 

Table 35. Career flows of current small cigarillo users for current users (26+ age group) .... 116 

Table 36. Career flow of past small cigarillo users (18-25 age group) ................................ 118 

Table 37. Career flows of past small cigarillo users (26+ age group) ................................. 119 

Table 38. HTP use socio-demographic breakdown (18-25 age group) ................................ 137 

Table 39. HTP use socio-demographic breakdown (26+ age group) .................................. 138 

Table 40. Career flows of use for current HTP users (18-25 age group) ............................. 149 

Table 41. Career flows of current HTP users (26+ age group) .......................................... 150 

Table 42. Career flow of past HTP users (18-25 age group) ............................................. 151 

Table 43 Career flows of past HTP users (26+ age group) ............................................... 152 

Table 44. Perception of HTPs (18-25 age group) ............................................................. 153 

Table 45 Perception of HTPs (26+ age group) ................................................................ 154 

Table 46. Perception of the HTPs (18-25 age group) ....................................................... 155 

Table 47 Perception of HTPs (26+ age group) ................................................................ 156 

Table 48. Views on settings where HTPs should be prohibited (18-25 age group) ............... 168 

Table 49. Views on settings where HTPs should be prohibited (26+ age group) .................. 169 

Table 50. Overview of non-harmonised taxes for heated tobacco products ......................... 172 

Table 51. Hypotheses proposed in the Schneider & Diehl (2016) model ............................. 177 

Table 52. Reasons for initiating use e-cigarettes ............................................................. 180 

Table 53. Perception of harmfulness e-cigarettes ............................................................ 181 

Table 54. E-cigarette use socio-demographic breakdown (18-25 age group) ...................... 186 

Table 55. E-cigarette use socio-demographic breakdown (26+ age group) ......................... 187 

Table 56. Career flows of use for current e-cigarette users (18-25 age group) ................... 201 

Table 57. Career flows of current e-cigarette users (26+ age group) ................................. 202 

Table 58. Career flow of past e-cigarette users (18-25 age group) .................................... 204 

Table 59. Career flows of past e-cigarette users (26+ age group) ..................................... 205 

Table 60. Perception of e-cigarettes (18-25 age group) ................................................... 207 

Table 61 Perception of e-cigarettes (26+ age group) ...................................................... 208 

Table 62 Views on settings where e-cigarettes should be prohibited (18-25 age group) ....... 217 

Table 63 Views on settings where e-cigarettes should be prohibited (26+ age group) ......... 218 

Table 64. Market size share of selected tobacco and related products by countries ............. 225 

Table  65.  Career  flows  of  use  for  current  users  of  HTPs  and  e-cigarettes  (18-25  &  26+  age 
groups) ............................................................................................................... 229 

Table 66. History of current exclusive users of HTPs and e-cigarettes (18-25 & 26+ age groups)
 .......................................................................................................................... 229 

Table 67. Influence of channels of information on use ..................................................... 231 

302 

 
Consumer preference and perception of specific categories of tobacco and related products 

Table 68. Relative risk perception of the products ........................................................... 232 

Table 69. Tax provisions applicable to manufactured tobacco ........................................... 234 

Table 70. Overview of non-harmonised taxes for e-cigarettes and heated tobacco products . 236 

Table 71. online survey sample description (18-25 age group) ......................................... 251 

Table 72. online survey sample description (26+ age group) ........................................... 254 

Table 73. Perceived appeal of product to youth (waterpipe; 18-25 age group) ................... 266 

Table 74. Perceived appeal of product to youth (waterpipe; 26+ age group) ...................... 266 

Table  75.  Extent  to  which  respondents  believed  that  youth  underestimate  risks  of  using 
waterpipe tobacco (18-25 age group) ..................................................................... 267 

Table  76.  Extent  to  which  respondents  believed  that  youth  underestimate  risks  of  using 
waterpipe tobacco (26+ age group) ........................................................................ 267 

Table 77. Perceived gateway effect of product (HTPs; 18-25 age group) ............................ 280 

Table 78. Perceived gateway effect of product (HTPs; 26+ age group) .............................. 281 

Table 79. Perceived appeal of product to youth (HTPs; 18-25 age group) .......................... 281 

Table 80. Perceived appeal of product to youth (HTPs; 26+ age group) ............................. 282 

Table 81. Extent to which respondents believed that youth underestimated risks of using HTPs
 .......................................................................................................................... 282 

Table 82. Extent to which respondents believed that youth underestimate risks of HTPs ...... 283 

Table  83.  Extent  of  agreement  with  regulating  the  product  like  cigarettes  (HTPs;  18-25  age 
group) ................................................................................................................ 283 

Table 84. Extent of agreement with regulating the product like cigarettes (HTPs; 26+ age group)
 .......................................................................................................................... 284 

Table 85. Perceived gateway effect of product (e-cigarettes; 18-25 age group) .................. 285 

Table 86. Perceived gateway effect of product (e-cigarettes; 26+ age group) .................... 285 

Table 87. Perceived appeal of product to youth (e-cigarettes; 18-25 age group) ................ 286 

Table 88. Perceived appeal of product to youth (e-cigarettes; 26+ age group) ................... 287 

Table  89.  Extent  to  which  respondents  believed  that  youth  underestimate  risks  of  using  e-
cigarettes ............................................................................................................ 288 

Table  90.  Extent  to  which  respondents  believed  that  youth  underestimated  risks  of  using  e-
cigarettes ............................................................................................................ 288 

Table 91. Regulating like cigarettes v. harm to passive users ........................................... 293 

303 

 
 
 
 
 
In person 

GETTING IN TOUCH WITH THE EU 

All over the European Union there are hundreds of Europe Direct information centres. You can find the 
address of the centre nearest you at: https://europa.eu/european-union/contact_en 

On the phone or by email 

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service: 

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– by email via: https://europa.eu/european-union/contact_en 

Online 

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Multiple copies of free publications may be obtained by contacting Europe Direct or your local information 
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can be downloaded and reused for free, for both commercial and non-commercial purposes. 

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ISBN 978-92-76-37788-7