Smokers who believed they were at increased risk of getting COVID-19 during the pandemic, or having a more severe case, were more likely to quit while those who perceived more stress increased smoking, according to new research published in the Journal of General Internal Medicine.
Nearly 70% of smokers believed smoking put them at increased risk for COVID and about 40% reported an increased desire to quit, yet almost one-third reported smoking more during the pandemic, which they attributed to stress among other reasons.
The study, conducted by investigators at Vanderbilt University Medical Center, Massachusetts General Hospital (MGH), and the University of Pittsburgh School of Medicine, informs health care providers with insights about how to help smokers during the pandemic.
"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. They need support with evidence-based treatment," said study co-leader Hilary Tindle, MD, MPH, who directs ViTAL, the Vanderbilt Center for Tobacco, Addiction, and Lifestyle.
Health care providers can connect smokers with evidence-based treatments such as FDA-approved medication to quit smoking and referral to smoking cessation programs including quitlines (1-800-QUIT-NOW) and Smokefree.gov that provide free counseling and medication.
Sixty-eight percent of respondents believed that smoking increases the risk of contracting COVID-19 or having a more severe case. This perceived risk was higher in Massachusetts where COVID-19 had already surged than in Pennsylvania and Tennessee, which were pre-surge when the survey was administered. Scott Lee, MD, of Vanderbilt University Medical Center contributed this context for COVID-19 case density by study site. 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 they smoked. Those who increased their smoking tended to perceive more stress.
Also, 11% of respondents who smoked in January 2020 (before the pandemic) had quit smoking by the time the survey was administered (an average of six months later), while 28% of former smokers relapsed. Higher perceived COVID-19 risk was associated with a higher likelihood of quitting and a lower likelihood of relapse.
"Studies have shown that alcohol and opioid use increased during the pandemic, but little is known about how smokers responded," 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 might have increased their smoking due to stress and boredom. On the other hand, the fear of catching COVID might have led them to cut down or quit smoking. In fact, we found that both happened, and we examined reasons for both outcomes," she said.
Rigotti and Tindle co-led the analysis of survey responses from 694 current and former daily smokers -- the average age was 53 years, 40% were male, and 78% were white-- who had been hospitalized before the COVID-19 pandemic and had previously participated in a smoking cessation clinical trial at hospitals in Boston, Nashville, Tennessee, and Pittsburgh, Pennsylvania. The survey was administered May-July 2020.
"Even before the pandemic, tobacco smoking was the leading preventable cause of death in the U.S. COVID-19 has given smokers yet another good reason to stop smoking," Rigotti said. "Physicians, health care systems, and public health agencies have an opportunity to educate smokers about their special vulnerability to COVID-19 and urge them to use this time to quit smoking for good."
This study further guides ongoing work by Drs. Tindle, Rigotti, Lee and colleagues to learn more about smokers who are calling state quitlines for help during the pandemic. The team will study how perceived risk of smoking and regional COVID-19 case density influence these quit attempts in about 40,000 smokers.
Funding for the study was provided by the National Heart, Lung and Blood Institute of the National Institutes of Health.
Smokers can access tobacco quitlines throughout the U.S. by calling 1-800-QUIT-NOW. Smokers can also visit ICOVIDQuit.org to view short videos of peers who successfully quit smoking during the pandemic.