Background: Changes in the prevalence of mental health problems among smokers due to the COVID-19 pandemic in England have important implications for existing health inequalities. This study examined the prevalence of psychological distress among smokers following the onset of the pandemic compared with previous years.
Methods: Cross-sectional data were used from a representative survey of smokers (18+) in England (n = 2,927) during four months (April to July) in 2016, 2017 and 2020. Adjusted logistic regressions estimated the associations between past-month psychological distress across two time periods (2016/17 and 2020), and age. Weighted proportions, chi-squared statistics and stratified logistic regression models were used to compare the distributions of minimal, moderate and severe distress, respectively, within socio-demographic and smoking characteristic categories in 2016/17 and 2020.
Results: The prevalence of moderate and severe distress among past-year smokers was higher in 2020 (moderate: 28.79%, 95%CI 26.11-31.60; OR=2.08, 95%CI 1.34-3.25; severe: 11.04%, 9.30-13.12; OR=2.16, 1.13-4.07) than in 2016/17 (moderate: 20.66%, 19.02-22.43; severe: 8.23%, 7.16-9.47). While there was no overall evidence of an interaction between time period and age, young (16-24 years) and middle-age groups (45-54 years) may have experienced greater increases in moderate and older age groups (65+ years) in severe distress from 2016/17 to 2020. There were also increases in 2020 of moderate distress among those from more disadvantaged social grades and of both moderate and severe distress among women and those with low cigarette addiction.
Conclusions: Between April-July 2016/17 and April-July 2020 in England there were increases in both moderate and severe distress among smokers. The distribution of distress differed between 2016/17 and 2020 and represents a widening of established inequalities, with increases in distress among socio-economically disadvantaged groups, women and diverging age groups.