SHORT REPORT
The double-edged relationship between COVID-19 stress and smoking: Implications for smoking cessation
 
More details
Hide details
1
The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
2
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, United States
3
Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
4
Department of Psychology, University of Waterloo, Waterloo, Canada
5
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
6
Ontario Institute for Cancer Research, Toronto, Canada
CORRESPONDING AUTHOR
Jeroen Bommelé   

The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725 - 3500 AS, Utrecht, The Netherlands
Submission date: 2020-06-27
Final revision date: 2020-07-20
Acceptance date: 2020-07-20
Publication date: 2020-07-27
 
Tob. Induc. Dis. 2020;18(July):63
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Although recent research shows that smokers respond differently to the COVID-19 pandemic, it offers little explanation of why some have increased their smoking, while others decreased it. In this study, we examined a possible explanation for these different responses: pandemic-related stress.

Material and Methods:
We conducted an online survey among a representative sample of Dutch current smokers from 11–18 May 2020 (n=957). During that period, COVID-19 was six weeks past the (initial) peak of cases and deaths in the Netherlands. Included in the survey were measures of how the COVID-19 pandemic had changed their smoking, if at all (no change, increased smoking, decreased smoking), and a measure of stress due to COVID-19.

Results:
Overall, while 14.1% of smokers reported smoking less due to the COVID-19 pandemic, 18.9% of smokers reported smoking more. A multinomial logistic regression analysis revealed that there was a dose-response effect of stress: smokers who were somewhat stressed were more likely to have either increased (OR=2.37; 95% CI: 1.49–3.78) or reduced (OR=1.80; 95% CI: 1.07–3.05) their smoking. Severely stressed smokers were even more likely to have either increased (OR=3.75; 95% CI: 1.84–7.64) or reduced (OR=3.97; 95% CI: 1.70–9.28) their smoking. Thus, stress was associated with both increased and reduced smoking, independently from perceived difficulty of quitting and level of motivation to quit.

Conclusions:
Stress related to the COVID-19 pandemic appears to affect smokers in different ways, some smokers increase their smoking while others decrease it. While boredom and restrictions in movement might have stimulated smoking, the threat of contracting COVID-19 and becoming severely ill might have motivated others to improve their health by quitting smoking. These data highlight the importance of providing greater resources for cessation services and the importance of creating public campaigns to enhance cessation in this dramatic time.

CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. J. Bommelé, P. Hopman, B. Hipple Walters, E. Croes and M. Willemsen, report grants from Dutch Ministry of Public Health, Welfare, and Sport, during the conduct of the study. C. Geboers reports grants from Longfonds, Hartstichting, KWF Kankerbestrijding, Trombosestichting, Diabetesfonds, during the conduct of the study. G.T. Fong reports grants from Ontario Institute for Cancer Research, during the conduct of the study and that he has served as an expert witness on behalf of governments in litigation involving the tobacco industry. A.C.K. Quah reports grants from Canadian Institutes of Health Research, during the conduct of the study.
FUNDING
This work was supported by the Dutch Ministry of Public Health, Welfare, and Sport. G.T.F. was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. A.C.K.Q. was supported by the Canadian Institutes of Health Research Foundation Grant (FDN- 148477). The sponsors had no role in the study design, data collection, interpretation of the data, writing of the article or the decision to submit it for publication.
AUTHORS' CONTRIBUTIONS
All authors contributed to the design of the study and its conduct. JB, PH and MW designed the questionnaire. JB analyzed the data and drafted the first manuscript. All authors actively contributed to subsequent drafts, and they all read and approved the final manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (16)
1.
Alqahtani JS, Oyelade T, Aldhahir AM, et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS One. 2020;15(5):e0233147. doi:10.1371/journal.pone.0233147.
 
2.
Klemperer EM, West JC, Peasley-Miklus C, Villanti AC. Change in tobacco and electronic cigarette use and motivation to quit in response to COVID-19. Nicotine Tob Res. 2020;1-2. doi:10.1093/ntr/ntaa072.
 
3.
Santé Publique France. Tabac, Alcool: quel impact du confinement sur la consommation des Français? [Tobacco, Alcohol: what impact does confinement have on French consumption?]. https://www.santepubliquefranc.... Accessed May 29, 2020.
 
4.
Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. doi:10.1186/s12967-020-02399-5.
 
5.
Sidor A, Rzymski P. Dietary choices and habits during COVID-19 lockdown: Experience from Poland. Nutrients. 2020;12(6):1-13. doi:10.3390/nu12061657.
 
6.
López-Bueno R, Calatayud J, Casaña J, et al. COVID-19 Confinement and Health Risk Behaviors in Spain. Front Psychol. 2020;11(June):1-10. doi:10.3389/fpsyg.2020.01426.
 
7.
Stanton R, To QG, Khalesi S, et al. Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health. 2020;17(11):1-13. doi:10.3390/ijerph17114065.
 
8.
Garcia-Alvarez L, De la Fuente-Tomas L, Saiz PA, Garcia-Portilla MP, Bobes J. Will changes in alcohol and tobacco use be seen during the COVID-19 lockdown? Adicciones. 2020;32(2):85-89. doi:10.20882/adicciones.1546.
 
9.
Government of The Netherlands. COVID-19: the Dutch steps after 11 May in simple language. https://www.government.nl/docu.... Published May 6, 2020. Accessed May 29, 2020.
 
10.
Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the Heaviness of Smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Addiction. 1989;84(7):791-800. doi:10.1111/j.1360-0443.1989.tb03059.x.
 
11.
Thompson ME, Fong GT, Boudreau C, et al. Methods of the ITC Four Country Smoking and Vaping Survey, wave 1 (2016). Addiction. 2019;114(S1):6-14. doi:10.1111/add.14528.
 
12.
Fong GT, Cummings KM, Borland R, et al. The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project. Tob Control. 2006;15(Suppl 3):iii3-iii11. doi:10.1136/tc.2005.015438.
 
13.
Siegel A, Korbman M, Erblich J. Direct and indirect effects of psychological distress on stress-induced smoking. J Stud Alcohol Drugs. 2017;78(6):930-937. doi:10.15288/jsad.2017.78.930.
 
14.
Yach D. Tobacco Use Patterns in Five Countries During the COVID-19 Lockdown. Nicotine Tob Res. 2020;1-2. doi:10.1093/ntr/ntaa097.
 
15.
da Silva Leonel ACL, Martelli-Junior H, Bonan PRF, Kowalski LP, da Cruz Perez DE. COVID-19, head and neck cancer, and the need of training of health students and practitioners regarding to tobacco control and patient counseling. Oral Oncol. 2020;106:104739. doi:10.1016/j.oraloncology.2020.104739.
 
16.
Fong GT, Jiang Y. The Importance of Reducing Smoking in China: To Achieve Healthy China 2030 While Reducing the Severity of the COVID-19 Pandemic. China CDC Weekly. 2020;2(22):404-406. doi:10.46234/ccdcw2020.103.
 
 
CITATIONS (25):
1.
COVID-19 et modifications du comportement tabagique
M. Underner, J. Perriot, G. Peiffer, N. Jaafari
Revue des Maladies Respiratoires
 
2.
Socio-Cognitive Factors Associated With Lifestyle Changes in Response to the COVID-19 Epidemic in the General Population: Results From a Cross-Sectional Study in France
Aymery Constant, Donaldson Conserve, Karine Gallopel-Morvan, Jocelyn Raude
Frontiers in Psychology
 
3.

Depression, Anxiety and Associated Factors Among Chronic Medical Patients Amid COVID-19 Pandemic in Mettu Karl Referral Hospital, Mettu, Ethiopia, 2020


Mohammedamin Hajure, Mandaras Tariku, Mustefa Mohammedhussein, Aman Dule
Neuropsychiatric Disease and Treatment
 
4.
Coping With Stress and Burnout Associated With Telecommunication and Online Learning
Nour Mheidly, Mohamad Fares, Jawad Fares
Frontiers in Public Health
 
5.
Carpe covid: using COVID-19 to communicate about harms of tobacco products
Lucy Popova
Tobacco Control
 
6.
Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID‐19 pandemic in Germany
Antonia Bendau, Jens Plag, Stefanie Kunas, Sarah Wyka, Andreas Ströhle, Moritz Petzold
Brain and Behavior
 
7.
The Impact of COVID-19 on Smoking Patterns in Pakistan: Findings From a Longitudinal Survey of Smokers
Kamran Siddiqi, Faraz Siddiqui, Amina Khan, Saeed Ansaari, Mona Kanaan, Mariam Khokhar, Ziauddin Islam, Masuma Mishu, Linda Bauld
Nicotine & Tobacco Research
 
8.
Tobacco and COVID-19: Understanding the science and policy implications
Luke Clancy, Silvano Gallus, Janice Leung, Catherine Egbe
Tobacco Induced Diseases
 
9.
Cardiovascular Disease and Coronavirus Disease 2019: Epidemiology, Management, and Prevention
Junichi Ishigami, Minghao Kou, Ning Ding, Kunihiro Matsushita
Current Epidemiology Reports
 
10.
Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic
Andrea Joyce, Grace Styklunas, Nancy Rigotti, Jordan Neil, Elyse Park, Gina Kruse
International Journal of Environmental Research and Public Health
 
11.
Worry about COVID-19 in relation to cognitive-affective smoking processes among daily adult combustible cigarette smokers
Justin Shepherd, Brienna Fogle, Lorra Garey, Andres Viana, Michael Zvolensky
Cognitive Behaviour Therapy
 
12.
Changes in Tobacco Use During the 2020 COVID-19 Lockdown in New Zealand
Philip Gendall, Janet Hoek, James Stanley, Mathew Jenkins, Susanna Every-Palmer
Nicotine & Tobacco Research
 
13.
The role of fear of COVID-19 in motivation to quit smoking and reductions in cigarette smoking: a preliminary investigation of at-risk cigarette smokers
Alexandra Gold, Danielle Hoyt, Megan Milligan, Michele Hiserodt, Jake Samora, Teresa Leyro, Michael Zvolensky, Michael Otto
Cognitive Behaviour Therapy
 
14.
Smoking and COVID-19: A Scoping Review
Chadia Haddad, Malhab Bou, Hala Sacre, Pascale Salameh
Tobacco Use Insights
 
15.
Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic
Jessica Yingst, Nicolle Krebs, Candace Bordner, Andrea Hobkirk, Sophia Allen, Jonathan Foulds
International Journal of Environmental Research and Public Health
 
16.
Are smokers protected against SARS-CoV-2 infection (COVID-19)? The origins of the myth
Westen-Lagerweij van, Eline Meijer, Elisabeth Meeuwsen, Niels Chavannes, Marc Willemsen, Esther Croes
npj Primary Care Respiratory Medicine
 
17.
A Qualitative study exploring older smokers' attitudes and motivation toward quitting during the covid-19 pandemic
Marisa Cordon, Ellie Eyestone, Sarah Hutchison, Daisy Dunlap, Laney Smith, Randi Williams, Emily Kim, Jen-Yuan Kao, Alejandra Hurtado-de-Mendoza, Cassandra Stanton, Kimberly Davis, Jennifer Frey, Brady McKee, Vicky Parikh, Kathryn Taylor
Preventive Medicine Reports
 
18.
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
Shihoko Koyama, Takahiro Tabuchi, Sumiyo Okawa, Takayoshi Kadobayashi, Hisaya Shirai, Takeshi Nakatani, Isao Miyashiro
Journal of Epidemiology
 
19.
Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults
Giulia Carreras, Alessandra Lugo, Chiara Stival, Andrea Amerio, Anna Odone, Roberta Pacifici, Silvano Gallus, Giuseppe Gorini
Tobacco Control
 
20.
Oncologic Emergency Medicine
Knox Todd
 
21.
Alcohol and Tobacco use While Breastfeeding and Risk of Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder
Louisa Gibson, Melanie Porter
Journal of Autism and Developmental Disorders
 
22.
Factors associated with changes in consumption among smokers and alcohol drinkers during the COVID-19 ‘lockdown’ period
Ciara Reynolds, Joanna Purdy, Lauren Rodriguez, Helen McAvoy
European Journal of Public Health
 
23.
Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European substance users
Jakob Manthey, Carolin Kilian, Sinclair Carr, Miroslav Bartak, Kim Bloomfield, Fleur Braddick, Antoni Gual, Maria Neufeld, Amy O’Donnell, Benjamin Petruzelka, Vladimir Rogalewicz, Ingeborg Rossow, Bernd Schulte, Jürgen Rehm
Substance Abuse Treatment, Prevention, and Policy
 
24.
ConVid - Pesquisa de Comportamentos pela Internet durante a pandemia de COVID-19 no Brasil: concepção e metodologia de aplicação
Celia Szwarcwald, Júnior Souza, Giseli Damacena, Deborah Malta, Marilisa Barros, Dalia Romero, Wanessa Almeida, Luiz Azevedo, Ísis Machado, Margareth Lima, André Werneck, Danilo Silva, Crizian Gomes, Arthur Ferreira, Renata Gracie, Maria Pina
Cadernos de Saúde Pública
 
25.
COVID-19 lockdown and lifestyles: A narrative review
Sathyanarayanan Doraiswamy, Sohaila Cheema, Mulla Al, Ravinder Mamtani
F1000Research
 
eISSN:1617-9625