Smokers who believed they were at increased risk of developing COVID-19 or having a more severe case during the pandemic were more likely to quit, while those who felt more stressed increased smoking, according to a new study published in the Journal of General Internal Medicine.
Almost 70% of smokers believed that smoking posed an increased risk of COVID, and around 40% reported an increased desire to quit, but nearly a third said they would smoke more during the pandemic, which they did among other things attributed to stress.
The study, which was conducted by investigators from Vanderbilt University Medical Center, Massachusetts General Hospital (MGH), and the University of Pittsburgh School of Medicine, is providing health care providers with insights on how to help smokers during the pandemic.
“A clear message is that many smokers want to quit during the pandemic but are hindered by high levels of stress and big changes in their daily routine. They need support with evidence-based treatment,” said Hilary Tindle, MD, MPH, Co- Head of the study. who runs ViTAL, the Vanderbilt Center for Tobacco, Addiction and Lifestyle.
Healthcare providers can connect smokers to evidence-based treatments like FDA-approved smoking cessation drugs and referrals to smoking cessation programs like Quitlines (1-800-QUIT-NOW) and Smokefree.gov, which offer free advice and medication.
68 percent of respondents believed that smoking increases the risk of developing COVID-19 or having a more severe case. That perceived risk was higher in Massachusetts, where COVID-19 had already increased, than in Pennsylvania and Tennessee, which were facing the increase at the time the survey was conducted. Scott Lee, MD, of Vanderbilt University Medical Center contributed this context to the COVID-19 case density by study location. Perceived COVID-19 risk was associated with a higher interest in quitting smoking.
During the pandemic, 32% of respondents increased their smoking, 37% decreased their smoking, and 31% did not change the number of cigarettes smoked. Those who smoked more tended to experience more stress.
In addition, 11% of respondents who smoked in January 2020 (before the pandemic) had stopped smoking by the time the survey was conducted (an average of six months later), while 28% of ex-smokers had relapsed. A higher perceived risk of COVID-19 was associated with a higher chance of quitting and a lower chance of relapse.
“Studies have shown that alcohol and opioid use increased during the pandemic, but little is known about how smokers reacted,” said lead author Nancy A. Rigotti, MD, director of MGH’s Tobacco Research and Treatment Center and professor of Medicine at Harvard Medical School.
“They may have increased their smoking because of stress and boredom. On the other hand, the fear of contracting COVID may have led them to reduce or quit smoking. In fact, we found that both happened and we investigated the reasons for both of the results, “she said.
Rigotti and Tindle jointly led the analysis of survey responses from 694 current and former daily smokers – the median age was 53, 40% were male, and 78% were white – who had been hospitalized prior to the COVID-19 pandemic and had previously been on participated in a clinical trial on smoking cessation in hospitals in Boston, Nashville, Tennessee and Pittsburgh, Pennsylvania. The survey was conducted from May to July 2020.
“Even before the pandemic, tobacco smoking was the number one preventable cause of death in the United States. COVID-19 has given smokers another good reason to quit, ”Rigotti said. “Doctors, health systems and public health authorities have the opportunity to educate smokers about their particular vulnerability to COVID-19 and to encourage them to use this time to quit smoking for good.”
This study continues the on-going work of Drs. Tindle, Rigotti, Lee and colleagues to learn about smokers calling government quitlines for help during the pandemic. The team will examine how perceived risk of smoking and regional COVID-19 case density affect these smoking cessation attempts in approximately 40,000 smokers.
Funding for the study was provided by the National Heart, Lung and Blood Institute of the National Institutes of Health.
Smokers in the US can access tobacco receipts at 1-800-QUIT-NOW. Smokers can also visit ICOVIDQuit.org to see short videos of their peers who successfully quit smoking during the pandemic.