Encephalopathy following subcutaneous administration of Brixadi® extended-release buprenorphine.

Globally, adolescent nicotine use remains a persistent public health concern. While overall tobacco use has declined in many settings, the World Health Organization reports persistently high numbers of young users and growing uptake of e-cigarettes among adolescents worldwide. The health risks of nicotine use are well established, and adolescents are particularly vulnerable because of ongoing neurobiological and psychosocial development. The rapid uptake of e-cigarettes and other non-combustible nicotine products among young people further raises concern, particularly in light of emerging evidence that nicotine itself may exert direct cardiovascular toxicity, independent of combustion. To prevent nicotine dependence and related harms, prevention — alongside regulation, structural measures such as smoke-free policies, and cessation support — remains essential. In this context, understanding adolescents’ information environments has become increasingly relevant, particularly the sources and channels through which they prefer to receive such information. In Germany, tobacco-control policies remain comparatively weak by international standards, with Germany ranked 34th out of 36 countries on the Tobacco Control Scale in 2021. Particularly notable is the absence of substantial public funding for national mass-media campaigns, as reflected by a score of 0 in the “Spending on public health information campaigns” category. This suggests structural gaps in population-wide communication efforts. At the same time, the nicotine-product landscape has changed considerably. Recent German data indicate a marked shift toward e-cigarettes and the emergence of nicotine pouches, while waterpipe use is declining and heated tobacco products remain rare among adolescents. In 2023, among 12–17-year-olds in Germany, current use was 7.4% for cigarettes, 6.7% for disposable e-cigarettes, and 3.9% each for reusable e-cigarette use and waterpipe use. Given this evolving product landscape, strategic selection of messengers and communication channels is critical for adapting prevention efforts to adolescents’ needs and media environment. Effective tobacco and nicotine prevention also depends on whether adolescents are willing to receive credible information and through which sources they prefer to receive it. Previous research points to several sources: clinicians, parents, schools, on-pack warnings, peers, and social media. Qualitative studies suggest that physicians and package warnings are often perceived as trustworthy, while peers and online media play a prominent role in everyday exposure to tobacco- and nicotine-related information. Experimental studies further show that messages from expert sources are rated as more credible and may increase adolescents’ perceptions of the harmfulness of tobacco and nicotine products compared with messages from peers or influencers. Thus, adolescents’ preferred information sources are not only a descriptive feature of their information environment, but may be relevant for the design and delivery of prevention messages.