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December 3, 2020 – Tobacco use has been on the decline for years in the United States, but the COVID-19 pandemic threatens this progress. Vaughan Rees, director of the Center for Global Tobacco Control, discussed how the stress of the pandemic and social distancing are affecting smokers.
Are more people smoking as a result of the pandemic?
We tend to look at large national polls to get very accurate estimates of smoking rates each year, and for many years we have seen steady drops in cigarette smoking among adults in the United States. there are market analyzes looking at recent sales of cigarettes and other tobacco products, and those data show that smoking rates among adults have increased in recent months while vaping rates among adults have declined. This is very concerning because it suggests a return to smoking among those who vape and is the opposite direction we want to go from a public health point of view. What is unclear is whether we are seeing more people smoking or if people currently smoking are consuming more. I suspect both trends are at stake.
Could the increase in smoking be mainly due to the stress of the pandemic and economic uncertainty?
There are many factors as to why staying at home during this pandemic could encourage smoking. There is stress, there are feelings of isolation, and perhaps some people have feelings of anxiety, fear and other negative emotions, which can serve as a trigger for tobacco use. But I think the other component is that we have done a great job of changing the accepted rules on smoking in public in the United States. Many people work in smoke-free environments, but when they are confined to their homes these rules may break. At home, smokers are less likely to be observed and judged by others, can set their own rules on where and when to smoke, and may have more time and opportunity to smoke. So suddenly the comfort of smoking is very different and there is the added stress layer of the pandemic that could act as a trigger. All of this could make it very difficult for someone to regulate their consumption or quit smoking.
Are there effective interventions that could be implemented during the pandemic?
Absolutely. Over the past decade we have seen the advent of some innovative smoking cessation interventions that can be delivered remotely, and these have been extensively evaluated. In recent years, the focus has been on dedicated smartphone apps and text-based interventions. Some of these apps will send a text message at certain times of the day or use a phone’s location information to identify when a person is in a high-risk situation where they could be exposed to a trigger. The really nice thing is that many of these interventions can be adapted to different populations, such as women, racial and ethnic minorities, people in the military or people who do not speak English. And these apps have proven to be quite effective, especially when paired with nicotine replacement therapies or other cessation medications.
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