The Impact of the COVID-19 Pandemic on Smoking Consumption: A Systematic Review of Longitudinal Studies

Abstract

The COVID-19 pandemic has generated a global health crisis that has negatively impacted the mental health and wellbeing of the population. A large amount of scientific literature has emerged since 2019, but none of these studies have focused on assessing the impact of COVID-19 on smoking consumption. We aimed to analyse the changes in smoking consumption during the COVID-19 pandemic through longitudinal studies. This systematic review follows the PRISMA Statement. This study was registered on PROSPERO (CRD42021282235). MEDLINE, ERIC, PsycARTICLES, Scopus, Web of Science and PsycINFO databases were searched from inception to 24 October 2021. We completed an extensive assessment of all prospective cohort studies that aimed to explore the effect of the COVID-19 pandemic on tobacco consumption habits. According to the PICOS's acronym, we included all population (P) types and studies developed before and during the COVID-19 pandemic (I) with a change in nicotine consumption as the outcome (O), as well as prospective cohort studies. The risk of bias was assessed using the Newcastle–Ottawa Scale for observational studies. The results showed that 14 cohorts reported in 11 articles fulfilled the inclusion criteria. A total of 58,052 participants were included in the review. Most of the studies pointed out a reduction in the number of cigarettes and e-cigarettes consumed from baseline (before the pandemic) to follow-up (during the pandemic). Only two studies reported an increase in cigarette or e-cigarette consumption from baseline to follow-up. The majority of studies presented a low risk of bias. In conclusion, the impact of the COVID-19 pandemic on smoking behavior is complex and uncertain. The decrease in smoking consumption during the pandemic could be related to the fear of becoming infected by COVID-19, the advancement of COVID-19, and the reduction in social gatherings. In several cases, the increases in nicotine consumption can be explained by psychological distress. These findings can be used to create strategies to prevent relapses during the post-vaccination phases of the pandemic.Systematic Review Registration: PROSPERO, identifier: CRD42021282235.

Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities

“…Of these, 25 papers related to mental health impacts, 13 to healthcare delivery, 12 to infection control, 13 to economic impacts, 7 to social impacts, and 3 to impacts on education. In addition, we identified systematic reviews of impacts on mental health [ 87 , 88 , 89 , 90 , 91 ], physical activity [ 46 , 65 , 92 , 93 , 94 ], diet and nutrition [ 47 , 65 , 66 , 67 , 68 ], body weight and obesity [ 48 , 71 , 72 ], alcohol consumption [ 49 ], and tobacco smoking [ 50 , 95 ], which we present in summary below, along with individual primary research papers of particular interest.…”

“…Regarding tobacco use, there were some studies with somewhat encouraging findings. For instance, in a systematic review of longitudinal studies that identified 14 cohorts in 11 published papers, with a total of 58,052 participants, Almeda et al (2022) [ 50 ] found that most studies indicated a reduction in the number of cigarettes and e-cigarettes consumed from before to during the pandemic. They found that studies with the highest mean daily stringency index for NPIs (in the UK, China, US, Pakistan, and Spain) detected reductions in the percentage of smokers [ 50 ].…”

“…For instance, in a systematic review of longitudinal studies that identified 14 cohorts in 11 published papers, with a total of 58,052 participants, Almeda et al (2022) [ 50 ] found that most studies indicated a reduction in the number of cigarettes and e-cigarettes consumed from before to during the pandemic. They found that studies with the highest mean daily stringency index for NPIs (in the UK, China, US, Pakistan, and Spain) detected reductions in the percentage of smokers [ 50 ]. For example, Niedzwiedz et al’s (2021) [ 100 ] longitudinal analysis of the UK Household Longitudinal Study ( n = 9748) found a reduction in smoking (RR 0.9, 95% CI 0.8–1.0), which appears to reflect a cessation among lighter smokers.…”

“…For all the polarisation of scientific and policymaking opinions in relation to specific population-level NPIs, there is a widespread consensus that the imposition of restrictions of this type is unequivocally associated with potential damages to economic activity and population health [ 10 , 44 , 45 ]. Numerous studies have investigated the effects of the NPIs on risk factors as listed above [ 46 , 47 , 48 , 49 , 50 ] and on health outcomes such as mental health [ 51 ]. A number of studies have raised concerns about potential harms to the public health through an increased burden of chronic disease, which might, in some contexts, outweigh the benefits of the reduced transmission of infection and actually exacerbate susceptibility to severe COVID-19 disease [ 47 , 52 , 53 ].…”

Smoking cessation and vaccination

“…The impact of the COVID-19 pandemic on smoking behaviour is complex and unclear. A recent systematic review that included 11 publications (58 052 participants) found that smoking consumption decreased during the pandemic in most cases [ 95 ]. Fear and social restrictions could be leading to an excellent opportunity to reduce or quit smoking.…”