Lessons Learned on Tobacco During the Pandemic

Lessons Learned on Tobacco During the Pandemic
Pattern shifts could inform future evidence-based addiction interventions.

New studies are beginning to quantify the public health effects of the pandemic and how more than a year of lockdown has impacted personal habits such as tobacco use.

Research reported in the Journal of General Internal Medicine found that smokers who believed they were at increased risk of getting COVID-19 or who suffered through severe cases were more likely to quit the habit. In contrast, those who perceived more stress during the same period were more likely to increase smoking.

“Understanding smokers’ responses to the pandemic will help assess its public health impact and inform future public health and provider messages to smokers,” wrote the authors, which included Hilary A. Tindle, M.D., director of the Vanderbilt Center for Tobacco, Addiction and Lifestyle (ViTAL).

Smoking Triggers

Tindle and colleagues sought to understand whether cigarette smokers’ perception of health risk, motivation to quit, or tobacco use changed during the early months of the U.S. COVID-19 pandemic. They wanted to determine whether the pandemic might offer a “teachable moment” for smokers.

Previous research has connected stress-provoking events with national impact – such as the 9/11 attacks – to an increase in smoking. Previous work by Tindle and others has also shown that people generally tend to smoke more frequently during times of stress.

“Despite stress triggers during COVID-19, it also seemed plausible that major changes in a person’s daily routine, as well as restrictions on large gatherings, might discourage smoking by providing fewer social cues,” Tindle said.

Perceptions and Patterns

The study population included 694 current and former daily smokers with an average age of 52 years, all of whom had previously enrolled in post-discharge smoking cessation clinical trials at hospitals in Massachusetts, Pennsylvania and Tennessee. About one third of the initial trial participants were recruited before the pandemic from Vanderbilt University Medical Center’s adult hospital. The current study survey was administered during the pandemic, between May and July 2020.

“A clear message is that many smokers want to quit during the pandemic yet are hindered by high stress and big changes in their daily routine.”

All participants provided information related to COVID-19 testing, exposure and illness. They answered questions related to their perceived infection risk and changes in smoking habits since the pandemic’s onset. The researchers also asked about overall stress levels and financial stressors.

The results showed 68 percent of respondents believed smoking increases COVID-19 risk, a fact in accordance with World Health Organization findings. Among respondents who were smoking in January 2020, 41 percent reported an increased interest in quitting, in part because they believed it would reduce their risk of developing COVID-19. “Curiously, neither perceived vulnerability to COVID-19 nor change in smoking behavior was associated with respondents’ personal experiences with COVID-19,” the authors noted, though the findings did appear connected to current surge rates at each of the three study sites.

Smokers largely fell into three groups during the pandemic: 32 percent of participants increased the number of cigarettes smoked per day; 31 percent reported no change in the habit; and 37 percent decreased smoking. Those who smoked more were more likely to be female, Hispanic, and to report higher overall stress levels.

Putting Lessons into Practice

“A clear message is that many smokers want to quit during the pandemic yet are hindered by high stress and big changes in their daily routine,” Tindle said. “They need support with evidence-based treatment.”

A separate study from Europe found the number of smokers attempting to quit rose by 10 percent during the pandemic.

The overall results suggest that perceived health risks may provide an opportunity to encourage smoking cessation.

“Aggressive public education about smoking as a risk factor for poor outcomes of COVID-19 could provide a cue to action, increasing interest in quitting and discouraging stress-induced increases in tobacco use,” wrote the authors.

The researchers encourage providers to refer patients to the national U.S. tobacco quitline (1-800-QUIT-NOW), which provides free counseling and medication in all 50 states and in some U.S. territories. Another resource is ICOVIDQuit.org, which contains information and short videos of peers who successfully quit smoking during the pandemic.

“Patients can also self-refer to these sites, as well as to Smokefree.gov, which has free information, texting programs and smartphone apps to help people quit smoking,” Tindle added.