title: Electronic Cigarettes-Attitudes and Use in Germany.
abstract: BACKGROUND
  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 Fagerström 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.
  
  
  CONCLUSIONS
  The study is the first description of attitudes and use of e-cigarettes in Germany.
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany; tobias.ruether@med.uni-muenchen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Rüther
authors.affiliation: Department of Health Promotion, Research School Caphri, Maastricht University, Maastricht, The Netherlands.
authors.forename: Franziska
authors.initials: F
authors.lastname: Wissen
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany;
authors.forename: Andrea
authors.initials: A
authors.lastname: Linhardt
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany;
authors.forename: Désirée S
authors.initials: DS
authors.lastname: Aichert
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany;
authors.forename: Oliver
authors.initials: O
authors.lastname: Pogarell
authors.affiliation: Department of Health Promotion, Research School Caphri, Maastricht University, Maastricht, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult