A Survey of Current Tobacco and Nicotine Product Users to Identify Barriers to Quitting Smoking in Germany.

BACKGROUND

Smoking rates remain high in Germany despite the well-known serious health risks. This survey assessed motivation to stop smoking in Germany and barriers to quitting smoking or switching to two types of smoke-free products (SFPs): e-cigarettes (E-cigs) and heated tobacco products (HTPs).

METHODS

In 2022, computer-assisted web interviews were conducted among adults (>19 years) who smoked (n=1,000) or used SFPs (n=196).

RESULTS

Overall, 51.2% of people who smoke were not motivated to stop smoking, 29.1% reported an intention to quit in the following year, and the remainder had some desire to quit but had not decided when to try. Lack of motivation was highest among people who smoke aged >65 years (64.4%) and lowest among those aged 19-34 years (38.9%). People with lower socioeconomic status who smoked had less motivation to quit than those with a higher socioeconomic status. In the sample of people who smoke, the barriers to quitting smoking included enjoyment of smoking (50.1%), difficulty in changing habits (41.4%), and lack of discipline (31.2%), with key differences among age groups. Only 27.3% of people who smoke perceived E-cigs/HTPs to have lower health risks relative to cigarettes, versus 84.7% of SFP users. Among SFP users, 41.8% reported a period of dual use when switching away from cigarettes. For the vast majority (89.1%), this period lasted less than a year, and 96.3% reported reduced cigarette consumption during this phase.

CONCLUSIONS

Despite the well-known health risks, a large number of people in Germany continue to smoke, with many not motivated to quit. The primary barrier to quitting is the enjoyment of smoking. Additionally, there are misperceptions about the relative risks of cigarettes versus SFPs among people who smoke. To effectively reduce smoking prevalence, targeted campaigns must address these barriers and correct these misperceptions. Existing tobacco control strategies should be supplemented with tobacco harm reduction approaches to drive down smoking prevalence as quickly as possible.