Jagomast Tobias, Tangemann-Münstedt Imke, Lüthgen Mareike, Faesser Henrike A, Lueg Thorben, Drömann Daniel, Franzen Klaas F
Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, Luebeck, Germany.
Praxis für Kardiologie Eutin/Timmendorfer Strand, Eutin, Germany.
Tob Use Insights. 2025 Jun 5;18:1179173X251338447. doi: 10.1177/1179173X251338447. eCollection 2025.
Smoking places a significant burden on healthcare systems, necessitating effective tobacco control measures. Pictorial health warnings (PHW) and tax increases have demonstrated great efficacy, yet their impact on cessation treatments and unintended shifts toward electronic nicotine delivery systems (ENDS) remains elusive. This study analyzes changes in public interest following these measures using online search volume for search terms regarding three categories: cessation, treatment, and ENDS.
An interrupted time series analysis was conducted. First, an online survey in Germany determined relevant tobacco control measures and search terms related to the three categories. Participants (n = 487) were ≥18 years old, with German as their first language. Second, the relative search volume (RSV) of Google for Germany regarding the identified search terms was analyzed around the enactment of the determined measures. This data is an anonymized aggregate of all Google users. Autoregressive integrated moving average models were used to estimate the change in RSV.
The survey identified tax increases and PHW as the most relevant tobacco control measures among selectable options. The tax increase in 2022 elicited a greater shift in RSV than the implementation of PHW in 2016. Substantial peaks in RSV only occurred following the tax increase, with no significant anticipatory effects. After the tax increase, interest in cessation-related terms seemed to rise (week 1: smoke free 6.53% [95% CI -6.78%-19.84%], quit smoking 12.17% [95% CI -0.15%-24.49%]), alongside a significant rise in searches for ENDS (week 2-3: e-cigarette 9.15% [95% CI 1.12%-17.19%], e-waterpipe 18.7% [95% CI 6.43%-30.96%]).
A tobacco tax increase may lead to increased online interest in ENDS. Policymakers should concurrently educate the public about the harms associated with ENDS and promote evidence-based cessation aids. This may discourage both the initiation of ENDS and their use for smoking cessation while redirecting public interest toward medically recommended alternatives.
吸烟给医疗系统带来了沉重负担，因此需要采取有效的烟草控制措施。图片健康警示（PHW）和提高税收已显示出巨大成效，但其对戒烟治疗的影响以及是否会意外导致向电子尼古丁传送系统（ENDS）的转变仍不明确。本研究使用关于戒烟、治疗和ENDS这三类搜索词的在线搜索量，分析这些措施实施后公众关注度的变化。
进行了一项中断时间序列分析。首先，在德国开展了一项在线调查，确定了相关的烟草控制措施以及与这三类相关的搜索词。参与者（n = 487）年龄≥18岁，以德语为母语。其次，在确定的措施颁布前后，分析了谷歌德国地区关于已确定搜索词的相对搜索量（RSV）。此数据是所有谷歌用户的匿名汇总数据。使用自回归积分滑动平均模型来估计RSV的变化。
调查确定提高税收和图片健康警示是可选选项中最相关的烟草控制措施。2022年提高税收引发的RSV变化比2016年实施图片健康警示更大。只有在提高税收后，RSV才出现大幅峰值，没有明显的预期效应。提高税收后，与戒烟相关术语的关注度似乎上升了（第1周：无烟6.53% [95%置信区间 -6.78% - 19.84%]，戒烟12.17% [95%置信区间 -0.15% - 24.49%]），同时ENDS的搜索量也显著增加（第2 - 3周：电子烟9.15% [95%置信区间1.12% - 17.19%]，水烟电子烟18.7% [95%置信区间6.43% - 30.96%]）。
提高烟草税可能导致在线上对ENDS的关注度增加。政策制定者应同时向公众宣传与ENDS相关的危害，并推广基于证据的戒烟辅助手段。这可能会抑制ENDS的使用以及将其用于戒烟的行为，同时将公众的兴趣引导至医学推荐的替代方法上。
