Electronic Cigarettes—Attitudes and Use in Germany

Introduction: Smoking is the leading preventable cause of death and disease. Previous studies on electronic cigarette (e-cigarette) use have reported reduction and cessation of conventional cigarette smoking; however, health effects are still a matter of discussion. This cross-sectional study investigated the attitudes of adults in Germany towards using e-cigarettes instead of or in addition to cigarettes. Furthermore, it examined the extent to which e-cigarettes are used as a smoking cessation tool.

Methods: In 2012, we recruited a sample of 319 participants comprising e-cigarette users (vapers, 33%), cigarette smokers (smokers, 37%) and smokers of both cigarette types (dual users, 30%). The Integrated Model for Change (I-Change Model) was used as a theoretical framework and a modified Fagerstrom Test of Nicotine Dependence was used to assess nicotine dependence. Data were collected by means of a questionnaire and smoking status was substantiated by measuring exhaled carbon monoxide.

Results: The vapers were more often men, were less addicted to nicotine and had a higher motivation to stop smoking than the smokers. In addition, vapers reported better health and had a lower carbon monoxide concentration than smokers. Furthermore, vapers had a more positive attitude towards e-cigarettes and higher self-efficacy in terms of abstaining from cigarettes in certain situations.

Conclusions: This is the first study to report on the use of e-cigarettes in Germany. Our results support those of previous studies in other populations. Further research is still needed on the potential health effects of e-cigarettes and their efficacy as a smoking cessation aid.

Implications: The study is the first description of attitudes and use of e-cigarettes in Germany.