Abstract
The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.
Highlights
There is growing concern surrounding the impact of smoking on susceptibility and severity of coronavirus disease (COVID-19)
The objective of the current study was to explore the impact of COVID-19 on smoking behaviors and risk perceptions, and to assess reactions to a remote cessation program with text messages and mailed nicotine replacement medications among primary care patients enrolled in a quit smoking trial during the initial surge of the pandemic and a statewide stay-at-home advisory
At the time of interview, none of our participants had reported testing positive for COVID-19
Summary
There is growing concern surrounding the impact of smoking on susceptibility and severity of coronavirus disease (COVID-19). Respiratory symptoms caused by cigarette use, along with the behavioral hand-to-mouth act of smoking, may increase smokers’. Risk of infection for COVID-19 [1,2]. Several studies have found that smoking is a risk factor for severe disease among hospitalized patients with COVID-19 [3,4]. COVID-19 mortality rates are higher among smokers [5,6,7]. There is evidence that smoking-related conditions, including cardiovascular disease, COPD, and diabetes mellitus, are associated with poorer COVID-19 outcomes [8,9,10,11,12].
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