Monday, May 29, 2023
HomeHarm ReductionDid COVID-19 stress and uncertainty stall anti-smoking push?

Did COVID-19 stress and uncertainty stall anti-smoking push?

A year after COVID-19 upended life for millions of Americans, there are troubling signs that the coronavirus may have also slowed progress against another deadly health threat – smoking, writes Matthew Perrone for AP. A Harvard survey of smokers reveals that around a third smoked more during the first six months of the pandemic.

Fewer smokers called quit-smoking hotlines last year and some smoked more, contributing to an unusual bump in cigarette sales – all in the middle of the stress, anxiety and uncertainty from the pandemic.

“It’s hard for folks to quit using tobacco in the best of times, so what happens when life is suddenly turned upside down?” said Jen Cash, who oversees Minnesota’s anti-tobacco programmes, according to the AP story published on 28 March 2021.

Researchers are already concerned about COVID-19′s impact on cancer screening and opioid overdoses as many Americans were cut off from routine care and examinations.

But services to help smokers quit – delivered via phone and online – would seem well-positioned to withstand the disruptions of the pandemic. The programmes help with devising a plan and often provide free nicotine gums and patches.

Yet, calls to states routed through a national hotline fell 27% last year to about 500,000 – the biggest drop in a decade, according to the North American Quitline Consortium. In a recent report, reports AP, the coalition of anti-smoking counsellors cited the pandemic and the drop in public awareness messaging.

“It’s really disturbing to see that the quit line calls have gone down so much because they’re exactly what I hoped would be going up,” said Dr Nancy Rigotti of Harvard Medical School, who was not involved in the report.

In a separate survey of 1,000 adult smokers, Rigotti and her colleagues found about a third reported smoking more during the first six months of the pandemic. Research has linked other traumatic events to relapses among ex-smokers, including after the 9/11 attacks.

The Centers for Disease Control and Prevention says it is too early to gauge the pandemic’s impact on smoking rates. In a statement, the CDC noted that although cigarette sales spiked around the first lockdowns last March, they have since fallen back to earlier levels. That suggests the rise was mainly smokers stocking up on cigarettes.

The US smoking rate has held steady at around 14% in recent years after a decades-long decline from over 40% in the 1960s. Smoking, which can cause cancer, strokes and heart attacks, is blamed for about 480,000 annual deaths.

The AP story continues: Because smoking overlaps with many other forms of addiction, the data on quit attempts is being closely watched by doctors who treat people who abuse drugs and alcohol, many of whom also suffer from depression and anxiety.

Quitting is notoriously difficult with just 7% succeeding, according to CDC figures. Many smokers are referred to quit-smoking hotlines at their annual check-up. Those appointments largely stopped last spring along with most other non-essential care.

Still, last year’s data on quit-smoking calls includes glints of positive news. Smokers who called Minnesota’s hotline reported smoking more, but also said they were more motivated to quit because of COVID-19. That mirrored national data showing smokers are aware that smoking can make them more vulnerable to serious illness from a coronavirus infection.

This is a shortened version of the AP story. See the full story via the link below.


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

Sara Kalkhoran, Douglas E Levy and Nancy A Rigotti

Affiliations: Harvard Medical School, Massachusetts General Hospital, and the Tobacco Research and Treatment Center at The Mongan Institute, all in Boston.

Posted on the preprint server medRxiv on March 20, 2021.




With 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 behaviours among US adult combustible cigarette smokers and electronic cigarette (e-cigarette) users.


In 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.


1,024 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).


Cigarette 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.

Competing interest Statement

Drs Kalkhoran and Rigotti received royalties from UpToDate, Inc. Rigotti has been an unpaid consultant to Pfizer, Inc. and a paid consultant to Achieve Life Sciences. Dr Levy has no financial disclosures.


AP story – Did COVID-19 stress, uncertainty stall anti-smoking push? (Open access)

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




Cumulative smoking especially associated with more severe COVID-19

Smoking associated with increased risk of COVID-19 – Or maybe not?

COVID-19 concerns cause more than a million Brits to quit smoking



Subscribe to our Newsletter

Receive Medical Brief's free weekly e-newsletter.

* indicates required