Smoking and Vaping Among a National Sample of U.S. Adults During the COVID-19 Pandemic

Abstract

IntroductionWith concerns about cigarette smoking being a risk factor for severe disease from COVID-19, understanding nicotine and tobacco use patterns is important for preventive efforts. We aimed to understand changes in product use behaviors among U.S. adult combustible cigarette smokers and electronic cigarette (e-cigarette) users.MethodsIn August 2020, we conducted a cross-sectional survey of a nationally-representative sample of adults age >18 in NORC’s AmeriSpeak Panel who reported past 6-month use of combustible cigarettes or e-cigarettes. Multivariable logistic regression assessed factors associated with increased product use and quit attempts since hearing about COVID-19.Results1024 past 6-month cigarette smokers and/or e-cigarette users were surveyed. Among cigarette smokers, 45% reported no change in cigarette smoking and 33% increased cigarette smoking since hearing about COVID-19. Higher stress was associated with increased cigarette smoking. Among e-cigarette users, 41% reported no change in and 23% reported increasing e-cigarette use. 26% of cigarette smokers and 41% of e-cigarette users tried to quit because of COVID-19. Higher perceived risk of COVID-19 was associated with attempts to quit combustible cigarettes (AOR 2.37, 95% CI 1.59-3.55) and e-cigarettes (AOR 3.14, 1.73-5.70).ConclusionsCigarette and e-cigarette use patterns varied in response to the COVID-19 pandemic. Most cigarette smokers and e-cigarette users perceived product use as increasing COVID-19-related health risks, and this was associated with attempts to quit. Others, especially those reporting higher stress, increased product use. Proactive provision of cessation support to smokers and e-cigarette users may help mitigate stress-related increases in product use during the COVID-19 pandemic.

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“…A study conducted in Holland found a greater proportion of smokers who reported smoking more compared to those who reported smoking less [ 57 ]. Increased smoking was also observed in China [ 58 ], Australia [ 59 ] and United States [ 60 ]. The increase in smoking behavior during the pandemic can be attributed to increased stress [ 60 ] and physical inactivity [ 61 ].…”

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“…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.…”

“…Some studies have examined if smokers tried to quit and/or successfully quit, either during, or because of, COVID-19 [ 30 , 34 , 40 , 43 – 45 ]. These studies have however reported highly variable estimates.…”

“…Another national study in the UK reported that a similar proportion of smokers (12%) made a quit attempt because of COVID-19 [ 43 ]. A nationally representative study in the US reported that 26% of smokers tried to quit [ 34 ], and an online US study of dual users (who smoke and vape) found that 23% tried to quit smoking in order to the reduce risk of harm from COVID-19 [ 30 ]. A study from Turkey among smokers in a cessation clinic [ 44 ] and a UK national study [ 45 ] reported that there was an increase in quit attempts during the pandemic as compared to before it.…”

“…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.…”