The Co-occurrence of Loneliness and Nicotine Use Among German Adolescents: A Cross-Sectional Analysis

Introduction Loneliness, a feeling of inadequate social relationships, is associated with behavioural health issues. This study examines the co-occurrence of loneliness and nicotine use (e-cigarettes, cigarettes and waterpipe (WP)) among adolescents aged 9-17 years in Germany. Methods Data were derived from the eighth wave of the “Präventionsradar”, an annual school-based survey in Germany. The sample included 23 009 adolescents aged 9-17 years, from 107 schools and 1449 classes, who completed online questionnaires between November 2023 and February 2024. Prevalence rates and multilevel logistic regression models were used to assess associations between loneliness, measured using the three-item UCLA Loneliness Scale, and current nicotine use, adjusting for covariates (age, gender, social status, sensation seeking, school type). Results Loneliness was reported by 31.5% of adolescents. It was associated with current cigarette use (OR 1.70, 95% CI 1.43-2.02), e-cigarette use (OR 1.59, 95% CI 1.38-1.83), WP use (OR 1.63, 95% CI 1.25-2.13), and any nicotine product use (OR 1.58, 95% CI 1.39-1.80). Early adolescents (11- to 14-year-olds) experiencing loneliness showed a higher risk of WP use (OR 1.90, 95% CI 1.16-3.13) and nicotine use (OR 1.39, 95% CI 1.07-1.80) compared to middle adolescents (15- to 17-year-olds). Conclusions Loneliness is prevalent and significantly linked to nicotine use among German adolescents, highlighting the need to address social factors in nicotine prevention efforts. The cross-sectional design limits causal inference.