Motivation to stop smoking in the German population: recent trends and associated factors (DEBRA study)

Background: A necessary requirement to initiate smoking cessation is motivation to stop smoking. Past research on which tobacco smokers are more motivated to stop smoking produced partially conflicting results. Especially, whether the use of e-cigarettes is associated with motivation to quit stays unclear. In addition, recent trends and factors associated with motivation to quit in Germany - a country with a high smoking prevalence (~28%) - have not been investigated to date. We aimed to examine if higher ratings on the Motivation to Stop Scale (MTSS) are associated with socio-demographics, nicotine dependence, past quit attempts, and use of e-cigarettes and other alternative tobacco products. Furthermore, we aimed to describe population trends in motivation to quit over the past five years in Germany.

Methods: We used data from the German Study on Tobacco Use: an ongoing cross-sectional face-to-face household survey collecting representative data of the German population every other month since 2016. We assessed associations in 19,257 adult current smokers with multivariable ordinal regression analyses and described MTSS scores between 2016 and 2021 (scores 1-7 = lowest to highest level of motivation).

Results: The mean MTSS score remained relatively stable at mean 2.04 (SD=1.37). Younger age, higher level of education, fewer cigarettes per day, more time spent with urges to smoke, a recent quit attempt, never vs. current use of water pipes and current or past e-cigarette use were associated with a higher MTSS score. The largest effect estimates were observed for at least one quit attempt during the past six months vs. no quit attempt in the past year (OR=7.54; 95%CI=6.78-8.40) and current vs. never use of e-cigarettes (OR=1.71; 95%CI=1.48-1.99).

Conclusion: Our findings show that recently failed quitters and current e-cigarette users are more motivated to quit smoking. Targeting these smokers with low-treshold support for smoking cessation may be feasible.