key: cord-0821332-2t6h9zvd
authors: Klemperer, Elias M; West, Julia C; Peasley-Miklus, Catherine; Villanti, Andrea C
title: Change in tobacco and electronic cigarette use and motivation to quit in response to COVID-19
date: 2020-04-28
journal: Nicotine Tob Res
DOI: 10.1093/ntr/ntaa072
sha: b18a1e902c91c1002e8abca5319ccf3534f9d520
doc_id: 821332
cord_uid: 2t6h9zvd

nan

M a n u s c r i p t 2 The recent onset of the coronavirus pandemic (COVID-19) has raised concerns that people who smoke may be at a greater risk of harm from infection 1 given the impact of cigarettes on respiratory disease and immune function. 2 Similarly, there is concern that electronic cigarette use may increase harm from COVID-19, 1 though evidence is lacking. 3 While a systematic review concluded that cigarette smoking is likely associated with increased harm from COVID-19, 4 a meta-analysis did not. 5 However, as noted by Berlin and colleagues, 6 the meta-analysis was limited by small sample sizes, resulting in large confidence intervals. 5 Berlin and colleagues describe findings from case series of smoking and COVID-19 as well as research from a prior coronavirus epidemic (MERS-CoV) that appear to support the association between smoking and adverse outcomes from COVID-19. 6 Regardless of the evidence on smoking and COVID-19, individual harm perceptions related to the virus may be inducing changes in tobacco use behavior. We recently conducted a cross sectional web-based survey of dual tobacco cigarette (TC) and electronic cigarette (EC) users to assess how past quit attempts differed between products. We also assessed changes in TC and EC use and motivation to quit due to COVID-19. We recruited participants using Amazon Mechanical Turk, a web-based crowd-sourcing service. Eligible participants were ≥21 years of age, lived in the United States, reported current or past use of TCs and ECs containing nicotine on >50% of days over a period of 30 days, and had attempted to reduce or quit ECs at some point in their life. Of the 593 who screened, 366 (61.7%) were eligible and completed the survey on April 10, 2020.

Participants responded to questions regarding demographics, tobacco use, and reasons for quitting. In addition, we asked participants how concerned about COVID-19 they are for their own health, the health of others, and how much they believed their use of TCs or ECs increased their risk of harm from COVID-19 (0=Not at all to 10=Extremely).

Participants also reported whether their 1) motivation to quit, 2) use, and 3) access to TCs A c c e p t e d M a n u s c r i p t 3 and ECs has decreased, remained the same, or increased since learning about COVID-19. Participants reported a mean concern about COVID-19 of 7.9 (SD=2.7) for their own TC; 48.0% EC), and a quarter reporting increased access (23.9% TC; 24.8% EC) to these products. There were positive but weak correlations between perceived risk of harm from A c c e p t e d M a n u s c r i p t 4 COVID-19 due to TC or EC use and motivation to quit for both TCs (rs=0.18, p<.01) and ECs (rs=0.18, p<.01). Perceived risk of harm was not associated with change in use or access to TCs or ECs.

Taken together, our findings suggest participants had varying reactions to COVID-19, but their responses were mostly consistent across TCs and ECs. Though almost half reported no change, COVID-19 prompted about a quarter of respondents to reduce their TC and EC use, and more than a third to increase their motivation to quit. Greater perceived risk was associated with increased motivation to quit both products, and over 20% of respondents reported a quit attempt in order to reduce risk of harm from COVID-19. These findings are consistent with recent quitline data showing increases in phone and website registrations in March 2020 compared to March 2019. 7 Thus, decreasing risk of harm from the pandemic may be an important motivator for some dual users to quit. On the other hand, about 30% of respondents increased their use and about 15% decreased their motivation to quit. Given the association between negative affect and smoking, 8 one possibility is that some TC and EC users are responding to pandemic-induced stress by increasing their use.

The generalizability of our findings are limited by the fact that we used a sample of Mechanical Turk workers 9 who had a history of attempts to reduce or quit TCs or ECs.

Future research is needed to examine change in dual use and quitting in a more representative sample and to examine how COVID-19 affects tobacco use behaviors longerterm. Research is also needed to understand the extent to which TCs and ECs increase risk of harm from COVID-19. Our findings suggest that, for some, COVID-19 may stimulate interest in reducing or quitting tobacco and serve as a novel opportunity to promote cessation or harm reduction during this pandemic.

A c c e p t e d M a n u s c r i p t

COVID-19: Potential Implications for Individuals with Substance Use Disorders

The health consequences of smoking-50 years of progress: A report of the surgeon general

Public health concerns and unsubstantiated claims at the intersection of vaping and COVID-19

COVID-19 and smoking: A systematic review of the evidence

Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)

COVID-19 and smoking

Vermont Department of Health. Daily Update on Novel Coronavirus (COVID-19)

Positive and negative affect as predictors of urge to smoke: Temporal factors and mediational pathways

Are Mechanical Turk worker samples representative of health status and health behaviors in the