A qualitative study exploring older smokers' attitudes and motivation toward quitting during the COVID-19 pandemic

Abstract

Older individuals who smoke are at increased risk of having severe outcomes from COVID-19, due to their long-term smoking and underlying health conditions. In this qualitative study, we explored the impact of COVID-19 on attitudes toward smoking and motivation to quit. Participants (N = 30) were enrolled in a larger ongoing randomized controlled smoking cessation trial conducted in the lung cancer screening setting. From March to May 2020, we assessed quantitative and qualitative responses to participants’ overall concern about COVID-19, changes in amount smoked, and motivation to reduce/quit smoking. Responses to the quantitative questions indicated that 64.3% of participants were extremely concerned with COVID-19, 20.7% reported reductions in amount smoked, and 37.9% reported increased motivation to quit. The qualitative responses, which were transcribed and coded using Consensual Qualitative Research guidelines, expanded upon these findings by providing the content of participants’ concerns, which included perceived risk of contracting COVID-19, the added stressors caused by COVID-19, and a variable impact on the amount smoked and motivation to quit. Although half of participants expressed extreme concern regarding COVID-19, fewer indicated increased motivation or reduced smoking. Qualitative themes suggested that the initial two months of the pandemic prompted some smokers to reduce or quit, but it exacerbated smoking triggers for others. Understanding how the pandemic continues to affect this vulnerable group will aid in adapting methods to support their efforts to stop smoking and remain abstinent.

Perceived Susceptibility to and Seriousness of COVID-19: Associations of Risk Perceptions with Changes in Smoking Behavior

“…Prior research has also documented both increased and decreased smoking during the pandemic [9,10,12], with people reporting a variety of reasons for changes in their smoking, such as disrupted schedules and social situations [12,[14][15][16], financial and logistical constraints [12,15,16], and stress [12,[14][15][16]. While health concerns of smoking and COVID-19 contributed to decreased smoking [12,[14][15][16], other factors were also influential. Other studies using the HBM to predict behavior and behavioral intentions during the pandemic [21][22][23][24][25][26][27][28][29][30] have also produced mixed results.…”

“…Perceived stress from the pandemic was significantly associated with both increased smoking and decreased smoking. Prior research has also documented both increased and decreased smoking during the pandemic [ 9 , 10 , 12 ], with people reporting a variety of reasons for changes in their smoking, such as disrupted schedules and social situations [ 12 , 14 , 15 , 16 ], financial and logistical constraints [ 12 , 15 , 16 ], and stress [ 12 , 14 , 15 , 16 ]. While health concerns of smoking and COVID-19 contributed to decreased smoking [ 12 , 14 , 15 , 16 ], other factors were also influential.…”

“…In a U.S. study, college students who smoked prior to pandemic-related campus closure reported significantly fewer smoking days during campus closure, and more than one quarter of them paused their tobacco use entirely [ 11 ]. In a small study of older adults, 27.6% reported increased and 20.7% decreased smoking [ 12 ]. Data from the Nielsen National Consumer Panel, representative of U.S. consumers, showed a 13.2% increase in tobacco sales during 1 April–30 June 2020, compared to the same dates in 2019 [ 13 ].…”

“…Data from the Nielsen National Consumer Panel, representative of U.S. consumers, showed a 13.2% increase in tobacco sales during 1 April–30 June 2020, compared to the same dates in 2019 [ 13 ]. Across adults of varying ages in the U.S. and Belgium, the reported reasons for decreasing smoking include spending more time around one’s children [ 14 ], spending less time in social situations that promote smoking [ 12 , 14 , 15 , 16 ], difficulty obtaining or affording cigarettes [ 12 , 15 , 16 ], and health concerns [ 12 , 14 , 15 , 16 ]. The reported reasons for increased smoking include increased stress [ 12 , 14 , 15 , 16 ], boredom [ 10 , 12 , 14 , 15 ], less social support for quitting smoking [ 15 ], and having greater flexibility in one’s schedule [ 14 , 16 ].…”

The relationship between COVID-19-specific health risk beliefs and the motivation to quit smoking: A UK-based survey

“…However, this increased engagement with smoking cessation was not universal, and in fact, was limited to a small percentage of the samples, with many participants showing no change or an increase in smoking behaviour. Qualitative reports revealed a complex relationship with smoking during the pandemic, with some of those who smoked reporting that the risk from COVID-19 was a trigger to quit, but the stress during the pandemic also triggered them to smoke as a coping mechanism ( Cordon et al, 2021 ). Indeed, stress and worry during the pandemic have been correlated with smoking as a coping mechanism ( Shepherd et al, 2021 ), and stress during the pandemic had a dual effect as it was correlated with higher smoking frequency in some participants who smoked, as well correlated with lower smoking frequency in others ( Bommele et al, 2020 ).…”