Changes in the reach of a smoking cessation program in Ontario, Canada, during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Given the harms associated with tobacco use, continuing the provision of smoking cessation treatment during the COVID-19 pandemic is critical. The aim of this study was to examine pandemic-related changes in enrolment, total treatment use and participant characteristics in a large, publicly funded smoking cessation program in Ontario, Canada. METHODS: We conducted a secondary data analysis of patients who enrolled in the program between Jan. 1, 2018, and Dec. 7, 2020. We used descriptive statistics to examine changes in treatment use. To test for differences in sociodemographic and health variables, we used segmented mixed-effects regression with a break point on Mar. 17, 2020, when Ontario declared a state of emergency. We tested 25 variables, using Holm's correction for multiplicity. RESULTS: We analyzed 60 373 enrolments. In the month after the break point, enrolments fell 69% and total visits fell 42% relative to previous years. After Mar. 17, 2020, those who enrolled were less likely to report employment in the previous week (absolute expected difference -12.4%, 95% confidence interval [CI] -15.0% to -9.8%); were more likely to be occasional (1.3%, 95% CI 0.6% to 1.9%) or noncurrent smokers (1.7%, 95% CI 0.8% to 2.6%); were less likely to have set a target quit date (-4.8%, 95% CI -7.0% to -2.6%); and were more likely to have a physical health (6.6%, 95% CI 4.0% to 9.2%), mental health (4.6%, 95% CI 1.9% to 7.2%) or substance use diagnosis (3.5%, 95% CI 1.3% to 5.6%). INTERPRETATION: Sharp decreases in new enrolments and subsequent visits to smoking cessation programs were seen when pandemic restrictions were implemented in Ontario, but the characteristics of the people who accessed the programs did not change markedly. Incorporating an equity perspective is essential when new models of care for smoking cessation are developed.

How a sample of English stop smoking services and vape shops adapted during the early COVID-19 pandemic: a mixed-methods cross-sectional survey.

BACKGROUND: The COVID-19 pandemic in England led to major changes in the delivery of support via stop smoking services (SSS) and to the widespread temporary closure of bricks and mortar e-cigarette retailers (vape shops herein). The impact of disruptions across the smoking cessation support landscape has not been fully documented. The purpose of this study was to capture how SSS and vape shops in England were affected and adapted their 'business as usual' during the early months of the COVID-19 pandemic. METHOD: An online cross-sectional survey was conducted between March and July 2020. Surveys were disseminated through online networks, professional forums and contacts. Open-ended qualitative responses were coded using thematic analysis. RESULTS: Responses from 46 SSS and 59 vape shops were included. SSS were able to adapt during this period, e.g. offering a remote service. A high percentage (74.6%) of vape shops had to close and were unable to make changes; 71.2% reported business declining. For both vape shops and SSS qualitative data revealed practical challenges to adapting, but also new pathways to support and co-working. CONCLUSION: The closure of vape shops appears to have most impacted smaller bricks and mortar shops affecting businesses by decline in customers and impacting staff (furlough). For those services that could stay open there may be lessons learned in how to support vulnerable and disadvantaged people who smoke by considering new pathways to support.

Potential benefits and hazards associated with the use of e-cigarettes - a guide for practitioners and current status in Poland.

The use of electronic cigarettes has dynamically increased over the last few years. Meanwhile, the knowledge regarding their safety has been rapidly changing, which could be a challenge for a medical practitioner. The purpose of this review is to summarize the latest reports and to verify statements on e-cigarettes' influence on health, including in the context of the ongoing SARS-CoV-2 pandemic. Awareness of the benefits of e-cigarettes can provide vital support for doctors caring for patients who smoke tra-ditional cigarettes. Nevertheless, attention should be paid to the dangers of the medically unjustified use of electronic cigarettes. Despite the idea of releasing e-cigarettes into the market as a harmless alternative to traditional cigarettes, this product also has a negative impact on health. Replacing traditional cigarettes with e-cigarettes provides well-documented benefits to patients with certain indications such as hypertension and asthma, as well as to smokers who intend to minimize the negative effects of passive smoking on their environment. Moreover, it could be valuable for patients who are willing to permanently overcome a nicotine addiction, especially when previous attempts to quit smoking with nicotine replacement therapy (NRT) monotherapy were unsuccessful. Electronic cigarettes are a rapidly developing technology and an innovative form of a well-known addiction, so it is essential for practitioners to stay informed.

Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data.

AIM: To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England. DESIGN/SETTING: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown. PARTICIPANTS: A total of 20 558 adults (≥ 16 years). MEASUREMENTS: The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant). FINDINGS: The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (ORadj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, ORadj  = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, ORadj  = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, ORadj  = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, ORadj  = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, ORadj  = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, ORadj  = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, ORadj  = 1.32, 95% CI = 0.64-2.75). CONCLUSIONS: Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.

COVID-19, smoking, vaping and quitting: a representative population survey in England.

AIMS: To estimate (1) associations between self-reported COVID-19, hand-washing, smoking status, e-cigarette use and nicotine replacement therapy (NRT) use and (2) the extent to which COVID-19 has prompted smoking and vaping quit attempts and more smoking inside the home. DESIGN: Cross-sectional household surveys. SETTING AND PARTICIPANTS: A representative sample of the population in England from April to May 2020. The sample included 3179 adults aged ≥ 18 years. MEASUREMENTS: Participants who reported that they definitely or thought they had coronavirus were classified as having self-reported COVID-19. Participants were asked how often they wash their hands after returning home, before preparing foods, before eating or before touching their face. They were also asked whether, due to COVID-19, they had (i) attempted to quit smoking, (ii) attempted to quit vaping and (iii) changed the amount they smoke inside the home. FINDINGS: Odds of self-reported COVID-19 were significantly greater among current smokers [20.9%, adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 1.04-1.73] and long-term (> 1-year) ex-smokers (16.1%, aOR = 1.33, 95% CI = 1.05-1.68) compared with never smokers (14.5%). Recent (< 1-year) ex-smokers had non-significantly greater odds of self-reported COVID-19 (22.2%, aOR = 1.50, 95% CI = 0.85-2.53). Bayes factors indicated there was sufficient evidence to rule out large differences in self-reported COVID-19 by NRT use and medium differences by e-cigarette use. With the exception of hand-washing before face-touching, engagement in hand-washing behaviours was high (> 85%), regardless of nicotine use. A minority (12.2%) of quit attempts in the past 3 months were reportedly triggered by COVID-19, and approximately one in 10 current e-cigarette users reported attempting to quit vaping because of COVID-19. CONCLUSIONS: In England, current smokers and long-term ex-smokers appear to have higher odds of self-reported COVID-19 compared with never smokers in adjusted analyses, but there were no large differences between people who used nicotine replacement therapy or e-cigarettes. Engagement in hand-washing appears to be high, regardless of nicotine or tobacco use. A minority of past-year smokers and current e-cigarette users, respectively, report attempting to quit smoking/vaping due to COVID-19.

Insights From the SmokeFree.gov Initiative Regarding the Use of Smoking Cessation Digital Platforms During the COVID-19 Pandemic: Cross-sectional Trends Analysis Study.

BACKGROUND: Smoking is a plausible risk factor for COVID-19 progression and complications. Smoking cessation digital platforms transcend pandemic-driven social distancing and lockdown measures in terms of assisting smokers in their quit attempts. OBJECTIVE: This study aims to examine trends in the number of visitors, followers, and subscribers on smoking cessation digital platforms from January to April 2020 and to compare these traffic data to those observed during the same 4-month period in 2019. The examination of prepandemic and postpandemic trends in smoking cessation digital platform traffic can reveal whether interest in smoking cessation among smokers is attributable to the COVID-19 pandemic. METHODS: We obtained cross-sectional data from daily visitors on the SmokeFree website; the followers of six SmokeFree social media accounts; and subscribers to the SmokeFree SMS text messaging and mobile app interventions of the National Cancer Institute's SmokeFree.gov initiative platforms, which are publicly available to US smokers. Average daily percentage changes (ADPCs) were used to measure trends for the entire 2020 and 2019 study periods, whereas daily percentage changes (DPCs) were used to measure trends for each time segment of change within each 4-month period. Data analysis was conducted in May and June 2020. RESULTS: The number of new daily visitors on the SmokeFree website (between days 39 and 44: DPC=18.79%; 95% CI 5.16% to 34.19%) and subscribers to the adult-focused interventions QuitGuide (between days 11 and 62: DPC=1.11%; 95% CI 0.80% to 1.43%) and SmokeFreeTXT (between days 11 and 89: DPC=0.23%; 95% CI 0.004% to 0.47%) increased, but this was followed by declines in traffic. No comparable peaks were observed in 2019. The number of new daily subscribers to quitSTART (ie, the teen-focused intervention) trended downward in 2020 (ADPC=-1.02%; 95% CI -1.88% to -0.15%), whereas the overall trend in the number of subscribers in 2019 was insignificant (P=.07). The number of SmokeFree social media account followers steadily increased by <0.1% over the 4-month study periods in 2019 and 2020. CONCLUSIONS: Peaks in traffic on the SmokeFree website and adult-focused intervention platforms in 2020 could be attributed to an increased interest in smoking cessation among smokers during the COVID-19 pandemic. Coordinated campaigns, especially those for adolescents, should emphasize the importance of smoking cessation as a preventive measure against SARS-CoV-2 infection and raise awareness of digital smoking cessation platforms to capitalize on smokers' heightened interest during the pandemic.

Changes in Smoking Behavior Since the Declaration of the COVID-19 State of Emergency in Japan: A Cross-sectional Study From the Osaka Health App.

BACKGROUND: In April 2020, the Japanese government declared a state of emergency due to the COVID-19 pandemic, and infection control measures, including requests to work from home and stay-at-home restrictions, were introduced. This study examined changes in smoking behavior during the COVID-19 state of emergency. METHODS: An online cross-sectional survey was conducted in Osaka, Japan. To assess differences in smoking behavior among 5,120 current smokers before and after the declaration of a state of emergency, prevalence ratios (PRs) for two outcomes, increased smoking and quitting smoking, were calculated using multivariable Poisson regression, adjusting for potential covariates. RESULTS: We found 32.1% increased the number of cigarettes smoked and 11.9% quit smoking. After adjustment for all variables, we found risk factors for COVID-19 (men and older age group) had both significantly higher PR for quitting smoking (men: PR 1.38; 95% confidence interval [CI], 1.17-1.62) and participants aged ≥65 years: PR 2.45; 95% CI, 1.92-3.12) and significantly lower PR of increased smoking (men: PR 0.85; 95% CI, 0.78-0.93 and participants ≥65 years: PR 0.38; 95% CI, 0.29-0.49). Additionally, respondents working from home or living alone had significantly higher PR for increased smoking (working from home: PR 1.29; 95% CI, 1.17-1.41 and living alone: PR 1.23; 95% CI, 1.10-1.38) and respondents who changed from cigarettes to heated tobacco products (HTPs) had significantly lower PR for quitting smoking (PR 0.150; 95% CI, 0.039-0.582). CONCLUSIONS: We suggest people who have high-risk factors for COVID-19 might change their smoking behavior for the better, while people who work from home or live alone might change their smoking behavior for the worse, during the COVID-19 state of emergency. Additionally, changing from smoking cigarettes to using HTPs makes smokers less likely to quit.

Changes in Smoking Behaviour and Home-Smoking Rules during the Initial COVID-19 Lockdown Period in Israel.

The COVID-19 pandemic has caused devastating impacts globally. To mitigate virus spread, Israel imposed severe restrictions during March-April 2020. An online cross-sectional survey was conducted in April 2020 among current and ex-smokers to explore changes in smoking behaviour and home-smoking rules during this period. Bivariate analysis and multivariate logistic regression examined associations between sociodemographic characteristics and perceived risk of infection and quitting smoking during the initial COVID-19 period. Current smoking was reported by 437 (66.2%) of the 660 participants, 46 (7%) quit during the initial restriction period, and 177 (26.8%) were ex-smokers. Nearly half (44.4%) of current smokers intensified their smoking, and 16% attempted to quit. Quitting during the COVID-19 period was significantly associated with higher education (adjusted odds ratio (aOR): 1.97, 95% CI: 1.0-3.8), not living with a smoker (aOR: 2.18, 95% CI: 1.0-4.4), and having an underlying chronic condition that increases risk for COVID-19 complications (aOR: 2.32, 95% CI: 1.1-4.6). Both an increase in smoking behaviour and in attempts to quit smoking during the initial COVID-19 pandemic were evident in this sample of adult Israeli smokers. Governments need to use this opportunity to encourage smokers to attempt quitting and create smoke-free homes, especially during lockdown conditions, while providing mental and social support to all smokers.

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic.

COVID-19 has become a global pandemic, with over 81 million cases worldwide. To assess changes in tobacco use as a result of the pandemic, we surveyed a convenience sample of current tobacco users between April and June 2020. The sample was taken from a tobacco user research registry (n = 3396) from the Penn State College of Medicine in Hershey, Pennsylvania, USA. Participants who responded to the survey and were eligible for this study (n = 291) were 25.6% male, 93% white, and had a mean age of 47.3 (SD = 11.6) years. There were no reports of participants testing positive for COVID-19, but 21.7% reported experiencing symptoms associated with the virus. Most participants (67%) believed that their risk of contracting COVID-19 was the same as non-tobacco users, but 57.7% believed that their risk of serious complications, if infected, was greater compared to non-tobacco users. A total of 28% reported increasing their cigarette use during the pandemic. The most common reasons for increased use were increased stress, more time at home, and boredom while quarantined. Nearly 15% reported decreasing their tobacco use. The most common reasons for reduced use were health concerns and more time around non-smokers (including children). A total of 71 (24.5%) users reported making a quit attempt. Characterizing these pandemic-related changes in tobacco use may be important to understanding the full scope of subsequent health outcomes resulting from the pandemic. Tobacco cessation resources should be tailored to allow for safe, appropriate access for those interested in quitting.

The Perceived Impact of COVID-19 among Treatment-Seeking Smokers: A Mixed Methods Approach.

The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.

Effect of coronaphobia on smoking habits.

INTRODUCTION AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) epidemic had exhibited negative effects on patients with a nicotine use disorder because of social stress situations. The objective of this study is to investigate the changes that occurred in the smoking habits of the patients who applied to our smoking cessation clinic because of the COVID-19 outbreak's effect (coronaphobia) on their mental health. METHOD: In this study, we included the patients who applied to our smoking cessation clinic between January 1 and June 30, 2020. We conducted telephonic and face-to-face interviews with the patients during the outbreak, and inquired about the changes in their smoking habits. RESULTS: In total, 114 volunteers (mean age: 41.2 years [min-max: 18-82 years], M/F: 70/44 [61.4/38.6%]) who registered in the smoking cessation clinic of Chest Diseases Clinic were included in the study. The number of people with and without coronaphobia was 64 (56.1%) and 50 (43.9%), respectively. The analyses of the changes in smoking behaviors because of coronaphobia demonstrated that people with coronaphobia exhibited a significantly higher decrease or cessation of smoking as compared to no change in smoking behavior or increase in the number of cigarettes (p: .006). CONCLUSIONS: Success in smoking cessation can be increased with the accurate analyses of the anxiety effects caused by coronaphobia after COVID-19 outbreak on the desire of smoking cessation. This resolution depends on the solution-oriented strategies that will increase the awareness of physicians and patients, a close follow-up of patients with tools such as telemedicine, and a quick determination of their needs.

Impact of COVID-19 on the Hong Kong Youth Quitline Service and Quitting Behaviors of Its Users.

Tobacco use is a possible risk factor for contracting and spreading COVID-19. We aimed to describe the impact of the COVID-19 pandemic on the Youth Quitline service and quitting behaviors of its users in Hong Kong. We conducted a telephone survey involving 201 participants of the Youth Quitline service, and retrospectively analyzed the operation and use of Quitline since the COVID-19 outbreak in Hong Kong. The number of incoming calls to the Youth Quitline and the participants' quit rate has increased since the COVID-19 outbreak in Hong Kong. Many participants (68%) did not realize that tobacco use potentially increased their risk for developing and spreading COVID-19; however, 43% agreed that the pandemic motivated their intention to quit, and 83% changed their smoking habits during the pandemic. These changes were mainly due to wearing masks (30%), closure of bars/pubs (25%), suspension of classes (14%), and being unable to socialize with friends (24%). Overall, 58% reduced their tobacco use; of these participants, 66% reported a ≥50% reduction in daily cigarette consumption. The participants reduced their smoking during the COVID-19 pandemic despite lacking knowledge about the potentially increased risk for contracting COVID-19 from continued smoking. The pandemic could create new opportunities to motivate young smokers to quit smoking, especially those seeking support for smoking cessation, and may further contribute to reducing the risks posed by COVID-19.

Perceived risk of infection and smoking behavior change during COVID-19 in Ohio.

OBJECTIVE: The recent COVID-19 pandemic may catalyze smoking behavior modification. The purpose of the study was to examine factors associated with reducing smoking exposure during the COVID-19 outbreak. DESIGN: Cross-sectional design using the Health Belief Model to develop an online survey distributed throughout Ohio early during the outbreak. SAMPLE: 810 adults in Ohio (77.9% non-smokers, 22.1% current smokers). MEASUREMENTS: Sociodemographic factors, smoking and behavior changes since the COVID-19 outbreak, and perceived risk of infection were collected. Logistic regression analyses were conducted to determine factors associated with indoor smoking bans and factors associated with desire to quit smoking since the outbreak. RESULTS: For the overall sample, the odds of indoor smoking bans were significantly associated with never smoked, college education, single-family residence, not living with smokers, and perceived importance of avoiding public places. For smokers, the desire to quit smoking since the COVID-19 outbreak was associated with diabetes and perceived risk of severe infection. CONCLUSIONS: Identified factors inform residential smoking exposure reduction through indoor smoking bans. Having an increased perceived risk of severe infection among smokers may motivate cessation. Public health nurses can provide accurate and accessible resources for smoking cessation during the COVID-19 pandemic to promote healthy lifestyle modification.

The Effect of the COVID-19 Pandemic on Smoking Cessation Success.

The coronavirus pandemic first started in Wuhan, China, in December 2019 and affected the whole world. In our country, new measures to be taken were announced after the first case was seen on March 11, 2020. In this study, patients who admitted to the smoking cessation clinic in 2018 and followed up by phone, regarding smoking cessation status in 2019 were questioned for their smoking cessation status after the coronavirus pandemic in 2020. In this descriptive study, the patients who applied to the smoking cessation outpatient clinic in 2018 were questioned regarding their smoking cessation status after 1 year and after the pandemic. It was investigated whether coronapandemia had an effect on smoking cessation. The data were evaluated by using SPSS 22 software. A value of p < 0.05 was considered significant. A total of 357 individuals with a median of Fagerström score of 7.0 were included in the study. Seventy-one (19.9%) of the subjects used nicotine tape, 268 (75.1%) used varenicline, and 18 (5.0%) used both. When the success of those who quit smoking before pandemic and those who quit smoking after pandemic were compared, a statistically significant relationship was found (p < 0.001). In our study, the rate of smoking cessation after 1 year was 23.7%, and the most common side effects were psychiatric complaints, whereas the rate of smoking cessation during the pandemic period was 31.1%. In order to increase the rate of smoking cessation, which is an important public health problem, more counseling should be provided, during the pandemic period.