Perceptions of Tobacco Product-Specific COVID-19 Risk and Changes in Tobacco Use Behaviors Among Smokers, E-Cigarette Users, and Dual Users

Abstract

Introduction Coronavirus Disease 2019 (COVID-19) is a public health crisis, but its effects on tobacco users remain ill-defined. This report aimed to assess the relationship between tobacco product-specific risk perceptions for COVID-19 and changes in tobacco use since the start of the pandemic. Methods A sample (n=776) of past-30 day exclusive smokers (n=238), exclusive e-cigarette users (n=143), and dual users (n=395) residing in the US and aged 18 or older was collected using Mechanical Turk from April 27 to June 8, 2020. Adjusted associations between tobacco product-specific COVID-19 risk perceptions (i.e. risk that smokers/vapers are at for COVID-19 relative to non-smokers/non-vapers) and changes in tobacco use since the pandemic began were assessed using partial proportional odds models. Results A majority of those who used cigarettes (63.7%) and e-cigarettes (56.1%) felt that the risk of COVID-19 was greater for users of their tobacco product than for non-users. Twenty-four percent of smokers had increased their cigarette use since the start of the pandemic and 28.0% had decreased. Similarly, 27.3% of e-cigarette users had increased their e-cigarette use since the start of the pandemic and 23.8% had decreased. Higher risk perceptions for COVID-19 were associated with reductions in tobacco use since the pandemic began for exclusive e-cigarette users and dual users. Conclusions These findings provide support that tobacco product-specific COVID-19 risk perceptions may be an important correlate of changes in tobacco use during the pandemic. Targeted information to inform tobacco users regarding their risks for COVID-19 is needed during this public health crisis.

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

“…Therefore, the relationship was not limited to individuals with a general expectancy of other negative health outcomes from smoking. Such an effect is consistent with the increase in motivation to quit since the pandemic began being driven directly by the novel COVID-19 threat, independent of existing health beliefs (Jackson et al, 2020;White et al, 2021).…”

“…For instance, Jackson et al (2020) found that during the first UK lockdown (beginning March 2020) there was an increase in the motivation to quit smoking and an increased number of attempts to quit. Further, reductions in smoking behaviour have also been found in multiple international surveys from across Netherlands, Pakistan, US, Italy, India, South Africa, and UK (Bommele et al 2020;Klemperer et al, 2020;Kowitt et al, 2020;Siddiqui et al, 2020;Tattan-Birch et al, 2020;White et al, 2021;Yach, 2020;Yingst et al, 2020). Within these samples, a proportion of smokers reported an increase in the motivation to quit smoking, increased quit attempts, or an actual decrease in smoking frequency during the pandemic.…”

“…Despite the increased engagement with smoking cessation, the majority of smokers did not change their smoking habits, and many smokers actually increased smoking frequency (Bommele et al 2020;Klemperer et al, 2020;Kowitt et al, 2020;Siddiqui et al, 2020;Tattan-Birch et al, 2020;White et al, 2021;Yach, 2020;Yingst et al, 2020). Qualitative reports from smokers revealed a complex relationship with smoking during the pandemic, with some smokers 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, 2020).…”

Smokers’ cognitive and behavioural reactions during the early phase of the COVID-19 pandemic: Findings from the 2020 ITC Four Country Smoking and Vaping Survey

“…While it is difficult to summarize and compare findings from the available literature due to differing methodologies between studies and inadequate reporting of the results in some cases, nonetheless, many of these studies have shown that a high proportion of smokers did not change their cigarette consumption during the pandemic [ 27 – 37 ]. Some studies have also reported that a similar proportion of smokers either increased or decreased smoking [ 27 , 31 , 32 , 35 ], while others have found that there was a higher proportion of smokers who increased smoking than reduced smoking [ 13 , 28 , 29 , 37 ]. Some studies only reported on either increasing [ 34 , 38 , 39 ] or decreasing [ 40 , 41 , 42 ] smoking, and these studies have shown highly varied estimates of either behavior.…”

“…Few studies have explored whether COVID-19 risk perceptions are related to changes in smoking. A national study in the UK showed that smokers who experienced significant stress about becoming seriously ill from COVID-19 were more likely to increase smoking [ 13 ], while other studies suggest that smokers who had greater concern of getting COVID-19 and/or those who perceive that smoking increases the risk of COVID-19, were more likely to be motivated to quit [ 31 ], reduce smoking [ 35 , 42 ] or make a quit attempt [ 34 ]. While some of these studies appear to show that COVID-19 may incentivise some smokers to quit, they are somewhat limited by methodological shortcomings, such as the use of convenience samples, sampling bias (e.g., not representative of the smoking population), and/or not evaluating a range of other variables that may be related to changes in smoking.…”