Abstract
INTRODUCTIONThe perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. This study aimed to examine the perceived risks of tobacco use on COVID-19 infection and severity, and possible COVID-related changes in perceptions of tobacco use and overall health.METHODSWe conducted an online survey of adults in the United States in June 2020 (n=2097). The survey covered cigarettes, cigars, e-cigarettes, and hookah. We also assessed changes in the use of any of the four tobacco products. Multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product, with the adjustment of demographic and COVID-19 related variables.RESULTSFor all four tobacco products, the perceived risks to general health were slightly higher during the pandemic than before the pandemic (77% vs 79.5% for cigarettes) and the perceived risk of COVID-19 severity was larger than the perceived risk of COVID-19 infection (73.3% vs 56.2% for cigarettes). All risk measures varied with tobacco products consistently, with the risks highest for cigarettes, then cigars, followed by e-cigarettes and hookah. Females and people with higher income or education were more likely to endorse the risks of tobacco use than their counterparts. People who perceived higher risks of using cigarettes (OR=1.65; 95% CI: 1.20–2.27) and cigars (OR=1.63; 95% CI: 1.17–2.27) to COVID-19 severity were more likely to have decreased or quit their use.CONCLUSIONSTobacco/nicotine use was perceived to increase the risk of COVID-19 severity and the perceived risk of tobacco/nicotine use to general health was high during the pandemic, particularly for cigarettes. The change of perceived risks appeared to be prompting harm-reducing changes in tobacco product use.
Highlights
The perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic
Perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic, given the uncertainty surrounding the association between smoking, vaping, and COVID-19 incidence and outcomes
It should be noted that the average value of perceived risks of COVID-19 infection were roughly 50%, with perceived risks associated with cigarettes and cigars above 50% and risks of e-cigarettes and hookah below 50%
Summary
The perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. Preliminary evidence indicates that smoking may be associated with a higher mortality rate and suffering more severe consequences of COVID-196,7, it is not clear if current smoking is associated with a reduced risk of COVID-19 infection[8,9,10] This initial research seems to contradict the hypothesis that smokers are at higher risk of disease severity due to mechanisms such as pre-existing lung disease or reduced lung capacity or higher rates of various other diseases among smokers compared to non-smokers, and have an increased transmission risk due to greater contact between fingers and lips and inhaling deeply near one’s fingers. The uncertainty and controversy may impact the perceived risk of tobacco use among both tobacco users and non-users
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