Is Germany on Track for a Tobacco-Free Europe by 2040? Smoking Patterns Across Population Subgroups

Background

The European Union (EU) aims to achieve a tobacco-free Europe by 2040. However, current smoking trends remain unfavorable, and it is unclear which vulnerable population groups are slowing the progress. Since education is a key social determinant of health behaviour, this study examines trends in cigarette smoking in Germany across educational levels, age groups, and gender. It also analyses how smoking-related inequalities have changed over time and whether rising educational attainment has influenced smoking patterns.

Methods

Data from the German Health Update (GEDA) survey (2008–2024) were analysed. Logistic regression was used to estimate predicted smoking probabilities and trends. Inequalities were assessed using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII). The preventive potential of higher education on smoking was estimated using the prevented fraction for the population (pfp).

Results

Smoking prevalence declined only among younger adults aged 18–39. In adults aged 40–64, trends varied by education, leading to increasing inequalities over time. Among those aged 65+, smoking rates increased across all educational groups. Despite this, higher education was consistently related to lower smoking rates. For example, among younger women, the proportion of prevented smoking cases associated with higher education rose from 13% in 2008 to 35% in 2024. Among older adults, smoking increases over time would have been stronger without rising educational attainment.

Conclusions

Smoking patterns in Germany remain concerning. Potential weaknesses in tobacco control implementation should be further investigated. Prevention policies should be better tailored to disadvantaged subgroups that have benefited least. Structural approaches, including improving educational attainment and strengthening tobacco control measures, are essential to achieve the EU goal of a tobacco-free Europe by 2040.

Key messages

• Smoking has declined only among younger adults in Germany, while inequalities by education have increased and smoking has risen among older age groups.

• Educational expansion has positively influenced smoking trends, but current trends still suggest existing tobacco control measures are insufficient to meet the EU 2040 tobacco-free goal.