The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations

Abstract

Aim While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic. Methods A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (e.g., social distancing, mask wearing) were examined. Results Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9±1.0 vs 11.6±1.0; p<.001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4±1.4 to 13.3±1.4, p=.024) as did those with higher levels of anxiety (from 11.5±1.1 to 13.6±1.1, p<.001). Conclusions Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use. Implications Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.

Impact of mandatory masking amid the COVID-19 pandemic on outdoor smoking: an interrupted time-series analysis of a 33-month unobtrusive observational study

“…Some studies showed that more smokers increased the use of tobacco products ( 8 , 9 ), while some showed more decrease in use ( 10 , 11 ). While most social distancing measures decreased the use of tobacco products, unemployment and anxiety may increase the use of tobacco products ( 12 , 13 ). Masking is an impact factor that might cause the reduction of smoking or quitting ( 14 ).…”

Effectiveness of a Smoking Cessation Program during the COVID-19 Pandemic

“…Moreover, participants faced some psychological issues following the outbreak of the pandemic. It was reported that higher levels of anxiety among patients may lead to increased tobacco consumption [38]. In another study, 18.5% of smokers reported lower cigarette consumption and 13.8% reported higher cigarette consumption following the pandemic [20].…”

Physical activity, sport participation, and cigarette smoking in university students after COVID-19 pandemic; Cross sectional analysis of the associations in south-eastern Europe

“…For example, a Californian study confirmed higher use of cigarettes during lockdown, which was explained by increased stress, changes in workplace, and increased opportunities for smoking or vaping (Gonzalez, Epperson, Halpern-Felsher, Halliday, & Song, 2021). Supportively, another US study noted an increase in smoking during the COVID-19 pandemic at the sample of adults from vulnerable populations, indicating unemployment and anxiety as factors which could contribute to greater risk of tobacco use (Wiley et al, 2023). Finally, a very comprehensive UK study discussed increased smoking as a coping mechanism to deal with anxiety, boredom, stress, and anger during the COVID-19 lockdown (Grogan et al, 2022).…”