ObjectivesWe aimed to describe population trends in motivation to stop smoking between 2016 and 2021 in Germany. Furthermore, the aim was to estimate to what extent higher ratings on the validated German version of the Motivation To Stop Scale (MTSS) are associated with sociodemographics, nicotine dependence, past quit attempts, and use of e-cigarettes and tobacco product alternatives.MethodsWe used data from the German Study on Tobacco Use: an ongoing repeated cross-sectional face-to-face household survey collecting representative data of the German population every other month since 2016. We analysed data from 18 969 adult current smokers with multivariable ordinal regression and described MTSS scores between 2016 and 2021 (scores 1–7=lowest to highest level of motivation).ResultsThe mean MTSS score was 2.04 (SD=1.37) and showed a slight downward trend over time. Younger age, higher level of education, fewer cigarettes per day, more time spent with urges to smoke, a recent quit attempt, no previous waterpipe use and current or past e-cigarette use were associated with higher MTSS scores. The largest effect estimates were observed for at least one quit attempt 0–6 months ago versus no attempt in the past year (OR=7.54; 95% CI 6.78 to 8.40), at least one quit attempt 7–12 months ago versus no attempt in the past year (OR=4.00; 95% CI 3.59 to 4.45) and for current versus never use of e-cigarettes (OR=1.71; 95% CI 1.48 to 1.99).ConclusionsRecent quit attempts and current use of e-cigarettes were associated with higher motivation to stop smoking in the German population. Actions to boost the general motivation to stop smoking are required.

Background Most smokers who are initially successful in their quit attempts return to smoking within the first few months. Identifying sub-populations at higher risk of relapse could help in relapse prevention efforts. We examined relapse rates in short-term abstainers who stopped smoking completely on their target quit date (TQD) and in those who needed more time to quit completely; and whether any difference in relapse between the two groups can be explained by baseline variables. Methods We identified 1,172 smokers who achieved biochemically validated abstinence four weeks after their TQD at a stop-smoking clinic in London, and compared those who were abstinent from the TQD (immediate quitters) and those who only stopped smoking later (delayed quitters) in baseline characteristics. In a subsample of 308 clients followed up at one year, we compared relapse rates in immediate and delayed quitters while controlling for potential confounders. Results Delayed quitters smoked their first cigarette of the day earlier, had more past quit attempts, had lower confidence in quitting successfully, were more likely female and more likely to use varenicline. One-year relapse rates were 53% for immediate quitters and 77% for delayed quitters (OR=2.83; 95%CI: [1.70-4.72]). In a multivariable regression adjusted for potential confounders delayed quitting remained significantly associated with relapse at one year (OR=2.41; 95%CI: [1.38-4.21]). Conclusion Ex-smokers who do not achieve abstinence on their TQD are at a higher risk of relapse than those who do. The effect was not explained by baseline variables. Implications Encouraging smokers to adhere to their TQD could improve treatment results. Relapse prevention efforts such as extended support and extended medication are likely to be particularly useful for delayed quitters.