BACKGROUND: Cigarette consumption showed varied trends during the COVID-19 pandemic, with some individuals reducing use due to health concerns and others increasing use due to stress. This study examined the early pandemic's impact on abstinence outcomes among tobacco users who were seeking smoking cessation (SC) services in Hong Kong.
METHODS: We conducted a secondary analysis of two cluster randomized controlled trials from 2018 to 2021 involving smokers using community-based SC services. We primarily assessed smoking cessation rates before and after January 25, 2020, when Hong Kong elevated its COVID-19 response level from "serious" to "emergency." Poisson regression models were used for analysis. Sensitivity analyses were conducted for February 8, 2020, when a 14-day mandatory quarantine for all arrivals from Mainland China was implemented, and March 28, 2020, when restrictions on public gatherings over four people and regulations on catering businesses (i.e., Max 50% seating capacity) were enacted. Subgroup analyses by the two trials were also performed.
RESULTS: A total of 1.762 participants (80.5% male) were included. Biochemically validated abstinence rates at the 6-month follow-up after January 25th (6.8% [51/748]) were lower than before January 25th (12.3% [125/1.014], Adjusted Risk Ratio (ARR) [95% CI]: 0.44 [0.30-0.65], p<0.001). The self-reported 7-day abstinence rates at the 3-month (31.3% [89/284] vs. 49.1% [725/1.478], ARR [95% CI]: 0.46 [0.35-0.60]) and 6-month follow-ups (32.2% [241/748] vs. 41.0% [416/1.014], ARR [95% CI]: 0.70 [0.60-0.81]) after January 25th were consistently lower than before (all ps<0.001). Subgroup analysis by different trials and sensitivity analyses showed the same lower abstinence rates after the policy changes.
CONCLUSIONS: The early stage of the COVID-19 pandemic had a significant negative impact on abstinence outcomes among tobacco users utilizing community-based SC services. Efforts to enhance support for smoking cessation during and after such public health crises are essential.