The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations

Abstract Aim While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic. Methods A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined. Results Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001). Conclusions Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use. Implications Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.

[1]  L. Santos,et al.  Alcohol Consumption and Smoking During Covid-19 Pandemic: Association with Sociodemographic, Behavioral, and Mental Health Characteristics , 2022, Journal of Community Health.

[2]  Jordan P. Davis,et al.  Substance Use, Financial Stress, Employment Disruptions, and Anxiety among Veterans during the COVID-19 Pandemic , 2022, Psychological reports.

[3]  R. McIntyre,et al.  Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death: A Systematic Review and Meta-analysis. , 2021, JAMA psychiatry.

[4]  D. Goff,et al.  Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries: A Systematic Review and Meta-analysis. , 2021, JAMA psychiatry.

[5]  Haiyan Yang,et al.  Smoking is independently associated with an increased risk for COVID-19 mortality: A systematic review and meta-analysis based on adjusted effect estimates , 2021, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[6]  V. Nguyen-Thanh,et al.  Changes in smoking and alcohol consumption during COVID-19-related lockdown: A cross-sectional study in France , 2021, European journal of public health.

[7]  M. Philbin,et al.  Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 “lockdown”: A qualitative study in the United States , 2021, International Journal of Drug Policy.

[8]  Y. Neumark,et al.  Changes in Smoking Behaviour and Home-Smoking Rules during the Initial COVID-19 Lockdown Period in Israel , 2021, International journal of environmental research and public health.

[9]  H. Zeeb,et al.  Engagement in Health Risk Behaviours before and during the COVID-19 Pandemic in German University Students: Results of a Cross-Sectional Study , 2021, International journal of environmental research and public health.

[10]  M. Khatatbeh,et al.  Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan , 2021, Tobacco use insights.

[11]  L. Bauld,et al.  The impact of COVID-19 on smoking patterns in Pakistan: findings from a longitudinal survey of smokers , 2020, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[12]  J. Bunn,et al.  Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage , 2020, JAMA network open.

[13]  D. Yach.  Tobacco Use Patterns in Five Countries During the COVID-19 Lockdown , 2020, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[14]  A. Villanti,et al.  Change in Tobacco and Electronic Cigarette Use and Motivation to Quit in Response to COVID-19 , 2020, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[15]  Paul A. Harris,et al.  The REDCap consortium: Building an international community of software platform partners , 2019, J. Biomed. Informatics.

[16]  Mariel S. Bello,et al.  Association of Cumulative Socioeconomic and Health-Related Disadvantage With Disparities in Smoking Prevalence in the United States, 2008 to 2017. , 2019, JAMA internal medicine.

[17]  D. Forde,et al.  Are posttraumatic stress and depressive symptoms pathways to smoking relapse after a natural disaster? , 2019, Drug and alcohol dependence.

[18]  S. Higgins,et al.  Understanding individual differences in vulnerability to cigarette smoking is enhanced by attention to the intersection of common risk factors. , 2018, Preventive medicine.

[19]  A. Kurti,et al.  Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample. , 2016, Preventive medicine.

[20]  S. Schroeder.  American health improvement depends upon addressing class disparities. , 2016, Preventive medicine.

[21]  J. Tidey,et al.  Smoking cessation and reduction in people with chronic mental illness , 2015, BMJ : British Medical Journal.

[22]  L. Beckert,et al.  Smoking Prevalence Increases following Canterbury Earthquakes , 2013, TheScientificWorldJournal.

[23]  M. Munafo,et al.  Socioeconomic status and smoking: a review , 2012, Annals of the New York Academy of Sciences.

[24]  Christopher E. Beaudoin.  Hurricane Katrina: Addictive Behavior Trends and Predictors , 2011, Public health reports.

[25]  G. Turecki,et al.  Alcohol and Cigarette Use and Misuse Among Hurricane Katrina Survivors: Psychosocial Risk and Protective Factors , 2009, Substance use & misuse.

[26]  S. Galea,et al.  Substance use and misuse in the aftermath of terrorism. A Bayesian meta-analysis. , 2009, Addiction.

[27]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[28]  Patrick Monahan,et al.  Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection , 2007, Annals of Internal Medicine.

[29]  B. Löwe,et al.  Detecting and monitoring depression with a two-item questionnaire (PHQ-2). , 2005, Journal of psychosomatic research.

[30]  J. Gault,et al.  Smoking and mental illness , 2001, Pharmacology Biochemistry and Behavior.

[31]  Y I Hser,et al.  A 33-year follow-up of narcotics addicts. , 2001, Archives of general psychiatry.

[32]  G. Ferrante,et al.  [Did social isolation during the SARS-CoV-2 epidemic have an impact on the lifestyles of citizens?] , 2020, Epidemiologia e prevenzione.

[33]  B. Lushniak,et al.  The Health consequences of smoking—50 years of progress : a report of the Surgeon General , 2014 .

[34]  W. McCarthy,et al.  Tobacco use as a distal predictor of mortality among long-term narcotics addicts. , 1994, Preventive medicine.