Effects of COVID-19-Related Disruptions on Service Use in a Large Smoking Cessation Program

Abstract

BackgroundThe COVID-19 pandemic caused a rapid shift to virtual care, with largely unknown consequences for accessibility. The purpose of this study is to examine pandemic-related changes in use of care for smoking cessation.MethodsWe conducted a secondary analysis 65,565 enrolments in a large smoking cessation program in Ontario, Canada. We used piecewise mixed effects regression to examine how weeks NRT received, as well as counseling provided and visits attended, varied with date of enrolment over three time periods: more than 6M before the pandemic began; the 6M before the pandemic; and the pandemic period itself. We then examined changes in the associations between use of care and participant characteristics by fitting a model including a set of interactions between time and other variables. Based on an omnibus test of these interactions, we then tested individual terms, using the Holm method to control the familywise error rate.ResultsFrom the start of the pandemic in March, 2020, total weeks of NRT provided rose significantly and then declined, while the amount of counseling fell. Associations between NRT use and participant characteristics changed significantly after the pandemic onset. Individual models showed that people with lower income, living in areas of higher marginalization, unable to work, and reporting higher levels of depressive symptoms all received NRT for a longer time during the pandemic period.ConclusionThe pandemic led to small but significant changes in the amount of services used per enrolment. The transition to remote care appears to have reduced the effects of socioeconomic and health barriers.IMPLICATIONSThe amount of care used by participants in tobacco cessation treatment is known to be associated with health and sociodemographic characteristics. Most of these associations did not change markedly following the pandemic-related switch to virtual care in 2020; however, the effects of some economic and health barriers seems to have lessened, perhaps due to a likely reduction in transport and time requirements of treatment.