Smoking Cessation in Germany: Drivers and Barriers
109 Pages Posted: 11 Feb 2022
Date Written: November 19, 2021
Despite a range of tobacco control policies enacted since the mid-2000s, rates of tobacco smoking in Germany are significantly higher than in many EU nations, and cessation rates remain lower. This report explores the structural reasons for Germany’s historical opposition to tobacco control both at the national and international level, examining historical, political, cultural, procedural, and economic impediments to reducing smoking. Tobacco control policies have recently been strengthened greatly in Germany as a result of EU, national and regional legislation. The new policies are examined to explore reasons why they may have been less successful than similar measures adopted elsewhere. Despite new policies, barriers to further progress in cessation remain. Germany’s relatively lax smoke-free policies are inside the purview of the states, which may be more susceptible to pressure from the tobacco industry and the hospitality lobby, both of which have resisted more comprehensive tobacco control efforts. Lack of public funding for NRTs and pharmacotherapies exacerbates disparities in smoking and related harms by inhibiting the quit rate among the poor. E-cigarettes appear to take on an especially important role aiding cessation attempts among German smokers who are unable or unwilling to pay for NRTs and pharmacotherapies. E-cigarettes, which have been shown in randomized controlled trials around the world to help smokers quit combustible tobacco, are now the most-used cessation aid in Germany. However, heavy regulation and taxation of e-cigarettes signal that experts and the government want to discourage their use, even by smokers using e-cigarettes to quit smoking. Proposed regulations, which would reduce the relative appeal of e-cigarettes by restricting advertising and imposing new taxes on e-liquids, could therefore undermine smoking cessation in Germany. Increases in sales illicit e-vapor products should also be anticipated in response to tax increases, and enforcement at the border and on the streets will be needed.
Keywords: cessation, smoking, ENDS, e-cigarettes, heated tobacco products, HTPs, HNB, tobacco taxes, political economy of smoking
JEL Classification: I18, D72
Suggested Citation: Suggested Citation