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The double-edged relationship between COVID-19 stress and smoking: Implications for smoking cessation
 
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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
 
 
Submission date: 2020-06-27
 
 
Final revision date: 2020-07-20
 
 
Acceptance date: 2020-07-20
 
 
Publication date: 2020-07-27
 
 
Corresponding author
Jeroen Bommelé   

The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725 - 3500 AS, Utrecht, The Netherlands
 
 
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.
 
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Xiaoyu Zhang, Yuying Sun, Derek Cheung, Man Wang, Yongda Wu, Kin Chak, Jianjiu Chen, Lok Leung, William Li, Tai Lam, Sai Ho
Nicotine & Tobacco Research
 
76.
The Impact of the COVID-19 Pandemic on Smoking Consumption: A Systematic Review of Longitudinal Studies
Nerea Almeda, Irene Gómez-Gómez
Frontiers in Psychiatry
 
77.
Belief and Recall of Nicotine as Therapeutic for COVID-19 May Undermine E-Cigarette Quitting Behavior
Nathan Silver, Elexis Kierstead, Bianca Tran, Lindsey Sparrock, Donna Vallone, Barbara Schillo
Health Education & Behavior
 
78.
Changes in the clustering of health-related behaviors during the COVID-19 pandemic: examining predictors using latent transition analysis
Camila Salazar-Fernández, Claire Mawditt, Daniela Palet, Paola Haeger, Mella Román
BMC Public Health
 
79.
Sustained decline in tobacco purchasing in Denmark during the COVID-19 pandemic
Toke Fosgaard, Alice Pizzo, Sally Sadoff
Communications Medicine
 
80.
The COVID‑19 pandemic and the consumption of tobacco and nicotine-containing products: a literature review
O. Salagay, G. Sakharova, N. Antonov, N. Stadnik
Public Health
 
81.
Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research
Neal Benowitz, Maciej Goniewicz, Bonnie Halpern-Felsher, Suchitra Krishnan-Sarin, Pamela Ling, Richard O'Connor, Mary Pentz, Rose Robertson, Aruni Bhatnagar
The Lancet Respiratory Medicine
 
82.
The influence of pro-vaping “gatewatchers” on the dissemination of COVID-19 misinformation on Twitter (Preprint)
Nathan Silver, Elexis Kierstead, Ganna Kostygina, Hy Tran, Jodie Briggs, Sherry Emery, Barbara Schillo
Journal of Medical Internet Research
 
83.
Substance Use Among Residents of Homeless Shelters During the COVID-19 Pandemic: Findings From France
Honor Scarlett, Maria Melchior, Camille Davisse-Paturet, Tarik Aarbaoui, Cécile Longchamps, Natasha Figueiredo, Simon Ducarroz
International Journal of Public Health
 
84.
Impact of a Coronavirus Pandemic on Smoking Behavior in University Students: An Online Survey in Türkiye
Fatma ÇELİK, Göksun DEMİREL
Turkish Journal of Pharmaceutical Sciences
 
85.
Person-centered patterns of substance use during the COVID-19 pandemic and their associations with COVID-related impacts on health and personal finances in young Black and White women
Tammy Chung, Carolyn Sartor, Alison Hipwell, Ashley Grosso, Yanping Jiang
Drug and Alcohol Dependence
 
86.
COVID-19 Lockdown Effects on Mood, Alcohol Consumption, Academic Functioning, and Perceived Immune Fitness: Data from Young Adults in Germany
Anna Koyun, Pauline Hendriksen, Pantea Kiani, Agnese Merlo, Jessica Balikji, Ann-Kathrin Stock, Joris Verster
Data
 
87.
Factors associated with smoking behaviour changes during the COVID-19 pandemic in Japan: a 6-month follow-up study
Takafumi Yamamoto, Hazem Abbas, Makiko Kanai, Tetsuji Yokoyama, Takahiro Tabuchi
Tobacco Control
 
88.
Changes in Cigarette Smoking and Smokeless Tobacco Use During the Coronavirus Disease 2019 Lockdown Period Among Youth and Young Adults in Denmark
Lotus Bast, Simone Kjeld, Marie Klitgaard
Nicotine & Tobacco Research
 
89.
Smoking and smoking addiction in future physicians during the COVID-19 pandemic; an example of a medical school in Turkey
Hatice Akbayram, Sibel Dogru
Journal of Substance Use
 
90.
Assessment of Mediterranean Diet Adherence and Lifestyle Change during COVID-19 National Lockdown in Tunisian Adult Population
Saoussen Turki, Khaoula Bouzekri, Tarek Trabelsi, Ati El
Nutrients
 
91.
Substance Use and Mental Health during the First COVID-19 Lockdown in Germany: Results of a Cross-Sectional Survey
Daniel Deimel, Christine Firk, Heino Stöver, Nicolas Hees, Norbert Scherbaum, Simon Fleißner
International Journal of Environmental Research and Public Health
 
92.
Barriers against and Motivations for Quitting Smoking during the COVID-19 Health Crisis: Results of a Qualitative Study in France
Romain Guignard, Guillemette Quatremère, Anne Pasquereau, Cécile Jartoux, Laure Salvaing, Guillaume Caline, François Beck, Thanh Nguyen
International Journal of Environmental Research and Public Health
 
93.
Racial and ethnic differences in distress, discrimination, substance use coping, and nicotine use among parents during COVID-19
Ashley Clawson, Ashley Cole, Christine Kurien, Alexandra Blair
Journal of Ethnicity in Substance Abuse
 
94.
Changes in individuals’ eating habits and mood, sleep quality, and lifestyle during COVID-19
Tevfik Kocak, Tek Acar, Busra Atabilen, Gamze Akbulut
European Journal of Environment and Public Health
 
95.
The Impact of the COVID-19 Pandemic on Stress, Isolation, Smoking Behaviors, and Motivation to Quit in People with HIV Who Smoke
Patricia Cioe, Robert Schnoll, Bettina Hoeppner, Robert Gross, Brian Hitsman, Frank Leone, Rebecca Ashare, Roger Vilardaga, Karen Tashima, Megan Pinkston, Christopher Kahler
AIDS and Behavior
 
96.
The Impact of the COVID-19 Pandemic on Smoking, Vaping, and Smoking Cessation Services in the United Kingdom: A Qualitative Study
Emily Johnston, Manpreet Bains, Abby Hunter, Tessa Langley
Nicotine & Tobacco Research
 
97.
The impact of the COVID-19 pandemic on cardiovascular health behaviors and risk factors: A new troubling normal that may be here to stay
Deepika Laddu, Elisabeth Biggs, Jill Kaar, Sherrie Khadanga, Rocio Alman, Ross Arena
Progress in Cardiovascular Diseases
 
98.
Remote Screening for Alcohol, Smoking, and Substance Involvement by Sex, Age, Lockdown Condition, and Psychological Care-Seeking in the Primary Care Setting during the COVID-19 Pandemic in México
Silvia Morales-Chainé, Rebeca Robles-García, Lydia Barragán-Torres, Claudia Treviño-Santa-Cruz
International Journal of Mental Health and Addiction
 
99.
Accelerating tobacco control at the national level with the Smoke-free Generation movement in the Netherlands
Marc Willemsen, Jasper Been
npj Primary Care Respiratory Medicine
 
100.
Associations of changes in smoking-related practices with quit attempt and smoking consumption during the COVID-19 pandemic: A mixed-methods study
Yingpei Zeng, Tzu Luk, Yongda Wu, Sau Tong, Wai Lai, Tai Lam, Man Wang
Tobacco Induced Diseases
 
101.
Exploration of Cardiology Patient Hospital Presentations, Health Care Utilisation and Cardiovascular Risk Factors During the COVID-19 Pandemic
Kenneth Cho, Giuseppe Femia, Rosa Lee, Denusha Nageswararajah, Haresh Doulatram, Kishor Kadappu, Craig Juergens
Heart, Lung and Circulation
 
102.
Associations between Tobacco Use, Surges, and Vaccination Status over Time in the COVID-19 Era
Brandon Reed, Arthur Brody, Andre Sanavi, Neal Doran
International Journal of Environmental Research and Public Health
 
103.
Changes in tobacco and e-cigarette consumption in Spanish university students during the COVID-19 lockdown: Identification of vulnerable groups
Víctor Villanueva-Blasco, Rodeiro Veiga, Verónica Villanueva-Silvestre, Folgar Isorna, Requeijo Otero, Andrea Vázquez-Martínez, Vicente Zanón-Moreno, Adelaida Lozano-Polo
Tobacco Induced Diseases
 
104.
E-Cigarette Users’ Profiles and Their Association with Identified Impacts of COVID-19 on Vaping among Young Adults in Malaysia
Salleh Mat, Nizam Baharom, Ching Siau, Caryn Chan, Noh Amit, Pei Sia, Lei Wee
Healthcare
 
105.
The association between tobacco or nicotine product use behaviors and non-compliance with mask wearing in COVID–19 pandemic period
Da-eun Lee, Heewon Kang, Sung-il Cho
Epidemiology and Health
 
106.
Smoking Behaviour and Dry Eye Symptoms Among Uitm Puncak Alam Students During Covid 19
Ahmad Binti, Abdul Bin, Nurulain Muhammad, Mahmood Wan
Malaysian Journal of Medicine and Health Sciences
 
107.
COVID-19 and Tobacco Cessation: Lessons from India
Monika Arora, Gaurang Nazar, Nitika Sharma, Neha Jain, Fiona Davidson, Sailesh Mohan, Deepa Mohan, MK Ali, V Mohan, Nikhil Tandon, K.M. Narayan, Dorairaj Prabhakaran, Linda Bauld, K. Reddy
SSRN Electronic Journal
 
108.
The combined lifestyle intervention CooL in times of COVID-19: a descriptive case series study
Ester Janssen, Nicole Philippens, Stef Kremers, Rik Crutzen
 
109.
SARS-Cov-2, Smoking, and Nicotine Consumption: Investigating the Intended and Unintended Consequences of Responses to COVID-19 around the World
Sam Hampsher
SSRN Electronic Journal
 
110.
Increased Nicotine Consumption in Australia During the First Months of the COVID-19 Pandemic
Phong Thai, Benjamin Tscharke, Jake O’Brien, Coral Gartner, Richard Bade, Cobus Gerber, Jason White, Qiuda Zheng, Zhe Wang, Kevin Thomas, Jochen Mueller
Nicotine & Tobacco Research
 
111.
Comparison of the baseline characteristics and influencing factors of successful smoking cessation before and during the coronavirus disease pandemic
Lei Zhu+, Rui Zhong+, Yanfang Qiu, Jianghua Xie, Yina Hu, Xinhua Yu, Xiaochang Chang, Wei Wang, Lemeng Zhang, Ouying Chen, Hui Cao, Yanhui Zou
Tobacco Induced Diseases
 
112.
Impact of COVID-19 lockdown on smoking and vaping: systematic review and meta-analysis
Dimitra Bakaloudi, Kleo Evripidou, Antonios Siargkas, Joao Breda, Michail Chourdakis
Public Health
 
113.
Potential Impact of the COVID-19 Pandemic on Public Perception of Water Pipes on Reddit: Observational Study
Zihe Zheng, Zidian Xie, Maciej Goniewicz, Irfan Rahman, Dongmei Li
JMIR Infodemiology
 
114.
The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel
Noah Rubinson, Geoffrey Fong, Shannon Gravely, Anne Quah, Michal Bitan, Ari Lev, Laura Rosen
BMC Public Health
 
115.
Are we equally at risk of changing smoking behavior during a public health crisis? Impact of educational level on smoking from the TEMPO cohort
Astrid Andersen, Irwin Hecker, Solène Wallez, Anke Witteveen, Antonio Lora, Ellenor Mittendorfer-Rutz, Giovanni Corrao, Henrik Walter, Josep Haro, Marit Sijbrandij, Matteo Compagnoni, Mireia Felez-Nobrega, Raffael Kalisch, Richard Bryant, Maria Melchior, Murielle Mary-Krause
BMC Public Health
 
116.
Experiences of nicotine users motivated to quit during the COVID-19 pandemic: a secondary qualitative analysis
Ramona Sharma, Danielle Rodberg, Laura Struik
BMJ Open
 
117.
A telephone-based smoking cessation intervention for individuals with COVID-19: A randomized controlled feasibility study
Joseph Grech
Tobacco Prevention & Cessation
 
118.
Changes in lifestyle-related behaviour during the COVID-19 pandemic in Japan: a questionnaire survey for examinees who underwent an annual health check-up
Miyako Kishimoto, Kayo Masuko, Sumie Yamamoto, Retsu Fujita, Shoko Nakamura, Masato Odawara, Mikio Zeniya
Journal of International Medical Research
 
119.
Impact of mandatory masking amid the COVID-19 pandemic on outdoor smoking: an interrupted time-series analysis of a 33-month unobtrusive observational study
Yuying Sun, Yongda Wu, Yee Cheung, Man Wang, Jianjiu Chen, Lok Leung, Xiaoyu Zhang, Kin Chak, Tai Lam, Sai Ho
Frontiers in Public Health
 
120.
PANDEMİYİ BÜTÜNCÜL OLARAK DEĞERLENDİREN NİTEL BİR ÇALIŞMA: PANDEMİ SÜRECİNİN SİGARA KULLANIM ALIŞKANLIKLARINA ETKİSİ
ACAR BULCA, YASİN KÖKSAL
ESTÜDAM Halk Sağlığı Dergisi
 
121.
Effect of COVID‐19 pandemic on lifestyle and bone mineral density in young adults
Darina Falbová, Viktória Kovalčíková, Radoslav Beňuš, Simona Sulis, Lenka Vorobeľová
American Journal of Human Biology
 
122.
Trends in daily cigarette consumption among smokers: a population study in England, 2008-2023
Sarah Jackson, Harry Tattan-Birch, Vera Buss, Lion Shahab, Jamie Brown
 
123.
Intended changes in smoking behaviour of Dutch young adults after an increase in excise tax: a cross-sectional survey
Kirsten Visscher, Babette Everaars, Anita Suijkerbuijk, Mattijs Lambooij, Wit de
BMJ Open
 
124.
Outcomes of the combined lifestyle intervention CooL during COVID-19: a descriptive case series study
Ester Janssen, Nicole Philippens, Stef Kremers, Rik Crutzen
BMC Public Health
 
125.
Smoking cessation in primary care
Yi Hui Adela Lua, Choon How How, Chung Wai Mark Ng
Singapore Medical Journal
 
126.
Effectiveness of Instant Messaging-Based Online Group Support for Preventing Smoking Relapse: a Pragmatic Randomized Controlled Trial
Wan Jia Aaron He, Qi Wang, Tai Hing Lam, Ching Han Helen Chan, Tzu Tsun Luk, Man Ping Wang, Siu Chee Sophia Chan, Yee Tak Derek Cheung
International Journal of Mental Health and Addiction
 
127.
Longitudinal Experience of Food Insecurity & Cigarette Use in the Early COVID-19 Pandemic, United States
Stephanie Pike Moore, Douglas D. Gunzler, Claire A. Spears, Nida Izhar Shaikh, Jin E. Kim-Mozeleski
Preventive Medicine Reports
 
128.
The association of psychological distress and economic and health worries with tobacco smoking behavior during the COVID-19 pandemic: a two-year longitudinal cohort study
Silvia Eiken Alpers, Karl Trygve Druckrey-Fiskaaen, Tesfaye Madebo, Jørn Henrik Vold, Ståle Pallesen, Jens Christoffer Skogen, Linn-Heidi Lunde, Silje Mæland, Lars Thore Fadnes
BMC Public Health
 
129.
Google Trends analysis of keywords related to smoking and smoking cessation during the COVID-19 pandemic in four European countries (Preprint)
Tobias Jagomast, Jule Finck, Imke Tangemann-Münstedt, Katharina Auth, Daniel Drömann, Klaas F. UKSH
 
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