The Impact of COVID-19 on Smoking Patterns in Pakistan: Findings From a Longitudinal Survey of Smokers

Abstract

Introduction We investigated the influence of COVID-19 on smoking patterns in Pakistan. Methods In a longitudinal survey, we asked cigarette smokers in Pakistan about their smoking behaviours before and since COVID-19. Smokers were recruited before COVID-19 using two-stage random probability sampling. Since COVID-19, three subsequent waves were conducted over the telephone, asking additional questions on social determinants, mental health and wellbeing. Based on the first two waves, we estimated the proportion of smokers who stopped, decreased, maintained, or increased smoking. We also explored any factors associated with the change in smoking patterns. In those who stopped smoking soon after COVID-19, we estimated the proportion relapsed in subsequent waves. We estimated all proportions based on complete-case analysis. Results We recruited 6,014 smokers between September 2019 and February 2020; of these, 2,087 (2,062 reported smoking outcomes) were followed up in May 2020 after COVID-19. Since COVID-19, 14% (290/2,062) smokers reported quitting. Among those who continued smoking: 68% (1210/1772) reduced, 14% (239/1772) maintained, and 18% (323/1772) increased cigarette consumption; 37% (351/938) reported at least one quit attempt; 41% (669/1619) were more motivated while 21% (333/1619) were less motivated to quit. Changes in smoking patterns varied with nicotine dependence, motivation to quit, and financial stability since COVID-19. Among those reporting quitting soon after COVID-19, 39% (81/206) relapsed in the subsequent months (June-July 2020). Conclusions There have been significant bidirectional changes in smoking patterns since COVID-19 in Pakistan. While many people stopped, reduced, or tried quitting smoking, some increased smoking, and some relapsed after quitting. Implications We observed significant and complex changes in people’s smoking patterns, which are likely to be attributable to the COVID-19 pandemic and replicated in similar events in the future. Assessing these changes are essential for most low- and middle-income countries like Pakistan, where the vast majority of tobacco users live, but cessation support is still rudimentary. If provided routinely, smoking cessation interventions can potentially support millions of highly motivated individuals in quitting successfully both in general as well as in global events like COVID-19, in particular.

Did self‐reported tobacco smoking, alcohol consumption, and physical activity change during the COVID-19 restrictions in Germany in spring 2020? Findings from a population survey (the DEBRA study)

“…Similar was reported by a group from Belgium: increase 7.4%, decrease 2.5% [28]. A different pattern was reported from Pakistan: of around 6000 interviewed smokers, 86% changed their smoking behaviour (increase 18%, decrease 68%) [33]. In contrast, a high increase (43%) in tobacco smoking was reported in a different study from Germany (N = 558) and was particularly observed among people with lower educational level or pandemic-related changes in the type of employment (leave of absence/home o ce) [39].…”

“…Current studies report heterogeneous results about the change in smoking, drinking behaviour, and physical activity [27][28][29][30][31][32][33][34][43][44][45]. Many of these studies were conducted as online surveys, and data were reported as being not representative for the general population of the respective countries.…”

“…Visiting bars or restaurants was severely or completely restricted during the aforementioned period, and these establishments were thus not eligible as a place for alcohol consumption. First data from other countries (e.g., United States [27], Belgium [28, 29], Australia [30], England [31,32], Pakistan [33], Italy [34], Scotland [35]) report changes in tobacco smoking, alcohol consumption and/or physical activity during the rst national COVID-19 restrictions. Whereas data from United States, England, and Belgium indicate a substantial increase in alcohol consumption [27,28,32], further data from England and Australia showed mixed results with a proportion of respondents who reported increased alcohol consumption and roughly the same proportion who drank less during this time [30,31].…”

“…As for tobacco consumption, ndings are also mixed. While a study from Belgium (web-based survey) and a longitudinal study conducted in Pakistan found an increase [28,33] in tobacco smoking, webbased surveys from Australia and England, as well as a cross-sectional study from England reported no changes in smoking behaviour [30,32,36], or even a strong reduction in tobacco smoking during the COVID-19 restrictions [33].…”

Changing Patterns of Substance Use During the Coronavirus Pandemic: Self-Reported Use of Tobacco, Alcohol, Cannabis, and Other Drugs

“…(11)]. Research into changing patterns of substance use is less common and often limited to alcohol and/or tobacco (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24); some studies (also) look into changes in the use of cannabis (25)(26)(27)(28)(29)(30), but few were found that included other drugs like "party drugs" that tend to be predominantly used in social contexts affected by the coronavirus measures (31)(32)(33).…”