Perceived health risks associated with the use of tobacco and nicotine products during the COVID-19 pandemic

Abstract

Perceptions of health risks and harms are associated with tobacco product experimentation, initiation, frequency, and intensity of use, as well as quit attempts [1][2][3] . In tobacco regulatory science, findings of health risk misperceptions that can promote harmful tobacco use behaviors are used to prompt and inform corrective action through new public education efforts or new requirements relating to product characteristics (e.g. flavors or appearance), product packaging, and labeling design, advertising and other marketing, warning labels, and educational package inserts 4,5 .Perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic, given the uncertainty surrounding the association between smoking, vaping, and COVID-19 incidence and outcomes. Preliminary evidence indicates that although smoking may be associated with a higher mortality rate and suffering more severe consequences of COVID-19 6,7 , it is not clear if current smoking is associated with a reduced risk of COVID-19 infection [8][9][10] . This initial research seems to contradict the hypothesis that smokers are at higher ABSTRACT INTRODUCTION The perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. This study aimed to examine the perceived risks of tobacco use on COVID-19 infection and severity, and possible COVID-related changes in perceptions of tobacco use and overall health. METHODS We conducted an online survey of adults in the United States in June 2020 (n=2097). The survey covered cigarettes, cigars, e-cigarettes, and hookah. We also assessed changes in the use of any of the four tobacco products. Multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product, with the adjustment of demographic and COVID-19 related variables. RESULTS For all four tobacco products, the perceived risks to general health were slightly higher during the pandemic than before the pandemic (77% vs 79.5% for cigarettes) and the perceived risk of COVID-19 severity was larger than the perceived risk of COVID-19 infection (73.3% vs 56.2% for cigarettes). All risk measures varied with tobacco products consistently, with the risks highest for cigarettes, then cigars, followed by e-cigarettes and hookah. Females and people with higher income or education were more likely to endorse the risks of tobacco use than their counterparts. People who perceived higher risks of using cigarettes (OR=1.65; 95% CI: 1.20-2.27) and cigars (OR=1.63; 95% CI: 1.17-2.27) to COVID-19 severity were more likely to have decreased or quit their use. CONCLUSIONS Tobacco/nicotine use was perceived to increase the risk of COVID-19 severity and the perceived risk of tobacco/nicotine use to general health was high during the pandemic, particularly for cigarettes. The change of perceived risks appeared to be prompting harm-reducing changes in tobacco product use.

Changes in Little Cigar and Cigarillo Use during the COVID-19 Pandemic: A Cross-Sectional Analysis of a Nationally Representative Sample of Young Adult Users

“…Nevertheless, the perceived risk of having COVID-19 when smoking LCCs was low in our sample. This finding builds upon previous research that reported cigar smokers, including LCC users, tend to underestimate its health risks compared to cigarettes [ 22 , 39 , 40 ]. Moreover, perceived COVID-19 risk may be related to how LCCs are smoked.…”

“…To our knowledge, no studies have investigated how perceptions about COVID-19 risks affect CAI and CAB use. Concurring with the literature that suggests perceived health risk of smoking is a strong predictor of smoking cessation status or quit attempts [ 19 , 20 , 21 ], a few studies showed that a higher perceived risk of COVID-19 is related to a higher likelihood of decreasing tobacco use [ 8 , 11 , 22 ], but those findings were not specific to LCCs.…”

Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research

“… 45 , 47 , 52 , 77 , 86 , 87 Such perceived risk of infection or disease severity, or concern over lung health more generally, was associated with reduced tobacco use. 49 , 79 , 80 , 86 , 88 , 89 , 90 , 91 , 92 Additional reasons for reduced tobacco use included wanting to help others who might have COVID-19; 88 concerns that parents might learn about their use; 49 and closure of bars and pubs, suspension of classes, and reduced socialising with friends. 52 Those with chronic illness were also more likely to reduce tobacco use during the pandemic.…”

Changes in Smoking Cessation–Related Behaviors Among US Adults During the COVID-19 Pandemic

“…Studies suggest that stress-related coping increases in cigarette smoking occurred among some smokers, whereas fears of COVID-19 health risks may have been associated with some individuals' decisions to reduce use of or quit tobacco products. [3][4][5][6][7] A 2022 analysis 8 of nationally representative crosssectional data from the Behavioral Risk Factor Surveillance System (BRFSS) survey reported a decrease in smoking prevalence during the COVID-19 pandemic but did not assess changes in smoking cessation behaviors. To address these gaps, we used 2 distinct but complementary data sources to investigate changes in past-year quit attempts, recent successful cessation, and sales of nicotine replacement therapies (NRTs; effective cessation treatments used by 25% of US smokers in quit attempts 1,9 ) before and during the COVID-19 pandemic in the US.…”