Smoking and E-Cigarette Use Among U.S. Adults During the COVID-19 Pandemic.

INTRODUCTION: With concerns about tobacco use being a risk factor for severe disease from COVID-19, understanding nicotine- and tobacco-use patterns is important for preventive efforts. This study aims to understand changes in combustible cigarette and E-cigarette use among U.S. adults. METHODS: In August 2020, a cross-sectional survey of a nationally representative sample of adults aged ≥18 years in the National Opinion Research Center's AmeriSpeak Panel who reported past 6-month use of combustible cigarettes or E-cigarettes was conducted. Multivariable logistic regression assessed the factors associated with increased product use and quit attempts since hearing about COVID-19. RESULTS: A total of 1,024 past 6-month cigarette smokers/E-cigarette users were surveyed. Among cigarette smokers, 45% reported no change in cigarette smoking, and 33% reported increased cigarette smoking since hearing about COVID-19. Higher stress was associated with increased cigarette smoking. Among E-cigarette users, 41% reported no change in E-cigarette use, and 23% reported increasing E-cigarette use. A total of 26% of cigarette smokers and 41% of E-cigarette users tried to quit because of COVID-19. Higher perceived risk of COVID-19 was associated with attempts to quit combustible cigarettes (AOR=2.37, 95% CI=1.59, 3.55) and E-cigarettes (AOR=3.14, 95% CI=1.73, 5.70). CONCLUSIONS: Cigarette and E-cigarette use patterns varied in response to the COVID-19 pandemic. Most cigarette smokers and E-cigarette users perceived product use as increasing COVID-19‒related health risks, and this was associated with attempts to quit. Some cigarette smokers, especially those reporting higher stress, increased product use. Proactive provision of cessation support to smokers and E-cigarette users may help mitigate the stress-related increases in product use during the COVID-19 pandemic.

Subsistence difficulties are associated with more barriers to quitting and worse abstinence outcomes among homeless smokers: evidence from two studies in Boston, Massachusetts.

BACKGROUND: Three-quarters of homeless people smoke cigarettes. Competing priorities for shelter, food, and other subsistence needs may be one explanation for low smoking cessation rates in this population. We analyzed data from two samples of homeless smokers to examine the associations between subsistence difficulties and 1) smoking cessation readiness, confidence, and barriers in a cross-sectional study, and 2) smoking abstinence during follow-up in a longitudinal study. METHODS: We conducted a survey of homeless smokers (N = 306) in 4/2014-7/2014 and a pilot randomized controlled trial (RCT) for homeless smokers (N = 75) in 10/2015-6/2016 at Boston Health Care for the Homeless Program. In both studies, subsistence difficulties were characterized as none, low, or high based on responses to a 5-item scale assessing the frequency of past-month difficulty finding shelter, food, clothing, a place to wash, and a place to go to the bathroom. Among survey participants, we used linear regression to assess the associations between subsistence difficulty level and readiness to quit, confidence to quit, and a composite measure of perceived barriers to quitting. Among RCT participants, we used repeated-measures logistic regression to examine the association between baseline subsistence difficulty level and carbon monoxide-defined brief smoking abstinence assessed 14 times over 8 weeks of follow-up. Analyses adjusted for demographic characteristics, substance use, mental illness, and nicotine dependence. RESULTS: Subsistence difficulties were common in both study samples. Among survey participants, greater subsistence difficulties were associated with more perceived barriers to quitting (p < 0.001) but not with cessation readiness or confidence. A dose-response relationship was observed for most barriers, particularly psychosocial barriers. Among RCT participants, greater baseline subsistence difficulties predicted less smoking abstinence during follow-up in a dose-response fashion. In adjusted analyses, individuals with the highest level of subsistence difficulty had one-third the odds of being abstinent during follow-up compared to those without subsistence difficulties (OR 0.33, 95% CI 0.11-0.93) despite making a similar number of quit attempts. CONCLUSIONS: Homeless smokers with greater subsistence difficulties perceive more barriers to quitting and are less likely to do so despite similar readiness, confidence, and attempts. Future studies should assess whether addressing subsistence difficulties improves cessation outcomes in this population. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02565381 .

Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study.

Background: Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain. Objective: To determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment. Design: Secondary data analysis of a randomized controlled trial. (ClinicalTrials.gov: NCT01714323 [parent trial]). Setting: 3 hospitals. Participants: 1357 hospitalized adult cigarette smokers who planned to stop smoking, received tobacco cessation counseling in the hospital, and were randomly assigned at discharge to a tobacco treatment recommendation (control) or free tobacco treatment (intervention). Measurements: Self-reported e-cigarette use (exposure) was assessed 1 and 3 months after discharge; biochemically validated tobacco abstinence (outcome) was assessed 6 months after discharge. Results: Twenty-eight percent of participants used an e-cigarette within 3 months after discharge. In an analysis of 237 propensity score-matched pairs, e-cigarette users were less likely than nonusers to abstain from tobacco use at 6 months (10.1% vs. 26.6%; risk difference, -16.5% [95% CI, -23.3% to -9.6%]). The association between e-cigarette use and quitting varied between intervention patients, who were given easy access to conventional treatment (7.7% vs. 29.8%; risk difference, -22.1% [CI, -32.3% to -11.9%]), and control patients, who received only treatment recommendations (12.0% vs. 24.1%; risk difference, -12.0% [CI, -21.2% to 2.9%]) (P for interaction = 0.143). Limitations: Patients self-selected e-cigarette use. Unmeasured confounding is possible in an observational study. Conclusion: During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. Additional study is needed to determine whether regular use of e-cigarettes aids or hinders smoking cessation. Primary Funding Source: National Heart, Lung, and Blood Institute.