For smokers, pandemic poses challenges, triggers

A picture of a researcher

December 3, 2020 – Tobacco use has been declining for years in the U.S., but the COVID-19 pandemic threatens that progress. Vaughan Rees, director of the Center for Global Tobacco Control, discussed how the stress of the pandemic and social distancing is impacting smokers.

Are more people smoking as a result of the pandemic?

We tend to look at big national surveys to get very precise estimates of smoking rates each year, and for many years we’ve seen steady declines in cigarette smoking among adults in the U.S. We don’t have much survey data for 2020 yet, but there are market analyses that look at recent sales of cigarettes and other tobacco products, and those data are showing that smoking rates among adults have gone up in recent months while vaping rates among adults have gone down. That is very concerning because it suggests a move back to smoking among those who vape and is the opposite direction we want to be heading from a public health perspective. What remains unclear is whether we’re seeing more people smoking, or whether people who currently smoke are consuming more. I suspect that both trends are in play.

Would the uptick in smoking be primarily driven by the stress of the pandemic and economic uncertainty?

There are many factors as to why being at home during this pandemic might encourage smoking. There’s stress, there are feelings of isolation, and maybe some people have feelings of anxiety, fear, and other negative emotions, all of which can serve as triggers for tobacco use. But I think the other component is that we’ve done a very good job at changing the accepted norms around smoking publicly in the U.S. Many people work in smoke-free settings, but when they’re confined to home those rules might break down. At home, smokers are less likely to be observed and judged by others, they can set their own rules about where and when to smoke, and they may have more time and opportunities to smoke. So suddenly the convenience of smoking is very different, and there’s the added layer of stress from the pandemic that could serve as a trigger. All of this could make it very difficult for someone to regulate their consumption or to quit smoking.

Are there any effective interventions that could be implemented during the pandemic?

Absolutely. Over the last decade we’ve seen the advent of some innovative smoking cessation interventions that can be delivered remotely, and these have been evaluated extensively. In recent years the focus has been on dedicated smartphone apps and text-based interventions. Some of these apps will deliver a text message at certain times of day or use a phone’s location information to identify when a person is in a high-risk situation in which they might be exposed to a trigger. The really nice thing is that many of these interventions can be tailored for different populations, such as women, racial and ethnic minorities, people in the military, or non-English speakers. And these apps have been shown to be quite effective, especially when coupled with nicotine-replacement therapies or other cessation medications.

Chris Sweeney