The Impact of the COVID-19 Pandemic on Smoking, Vaping, and Smoking Cessation Services in the United Kingdom: A Qualitative Study

Impact of Physical Activity on Health Behavior Change and Mental Health During the COVID-19 Epidemic Among Chinese Adults: China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

The COVID-19 pandemic caused significant disruptions to daily life, affecting regular physical activity (PA) and health behaviors worldwide. This study investigates the associations between PA domains and changes in health behaviors and mental health outcomes among middle-aged and old Chinese adults.

METHODS

Using wave 5 cross-sectional data from the 2020 China Health and Retirement Longitudinal Study, we analyzed 17,180 adults aged 45 and above, focusing on health behavior changes such as smoking, alcohol consumption, dietary adjustments, and panic purchasing, as well as mental health outcomes like anxiety and fear. PA was classified by intensity levels-light, moderate, and vigorous-and by activity purposes-total, leisure, and occupational.

RESULTS

The findings indicate that leisure PA is associated with healthier behaviors, including lower odds of increased smoking (OR = 0.71, 95% CI: 0.57-0.90) and alcohol consumption (OR = 0.70, 95% CI: 0.54-0.90), whereas occupational PA is linked to adverse behavioral outcomes, such as higher odds of smoking (OR = 1.45, 95% CI: 1.15-1.83) and alcohol use (OR = 1.43, 95% CI: 1.10-1.86). Additionally, participants engaged in all domains of PA were more likely to experience anxiety and fear compared to those who were physically inactive.

CONCLUSIONS

Our limited understanding of the role PA has on behavioral and mental health during public health crises highlights the importance of having tailored strategies to enhance resilience in similar future scenarios.

Factors influencing smoking cessation: Insights from Singapore's nationwide health and lifestyle survey

Introduction

Singapore has implemented an evidence-based smoking cessation framework to support smokers in quitting. Our study investigated the prevalence and correlates of (1) quit attempts (QA) and quit intentions (QI) among current smokers, and (2) smoking cessation (SC) among ever-smokers in Singapore.

Method

Data was collected from a nationwide survey conducted between 2020 and 2022. QA was defined as attempting to stop smoking at least once in the past 12 months, while QI was defined as planning to quit smoking within the next 30 days or the next 6 months. SC referred to individuals who quit smoking over 6 months ago. Sociodemographic factors, doctor's advice to quit and perceived harm from smoking were assessed using logistic regression among current smokers (n=1024) and ever-smokers (n=1457).

Results

Among current smokers, 31.3% and 41.2% reported QI and QA, respectively. Smokers with secondary or pre-tertiary education were less likely to report QI compared to those with a degree or higher. Doctor's advice to quit was associated with a higher likelihood of QA. Among ever-smokers, 25.3% reported SC, and this was more likely when they perceived smoking 1 or more packs of cigarettes daily as posing a moderate or high health risk.

Conclusion

Educational campaigns should focus on simplifying messages for individuals with lower literacy levels. Smoking cessation training can be incorporated into medical education, and graphic health warnings on cigarette packs can help effectively communicate the dangers of smoking.

How Should a Vape Shop-Based Smoking Cessation Intervention Be Delivered? A Qualitative Study

INTRODUCTION

Encouraging smokers to quit smoking tobacco using e-cigarettes could substantially reduce smoking-related diseases. Vape shops (VS) therefore have the potential to play an important role in supporting smoking cessation. The aim of this study was to explore how to deliver a vape shop-based smoking cessation intervention in the United Kingdom.

METHODS

Semistructured telephone interviews were undertaken with four stakeholder groups: 20 stop smoking service (SSS) providers, seven tobacco control leads, seven smokers/vapers, and five vape shop staff. Interviews were analyzed thematically.

RESULTS

Stakeholder groups were positive about the idea of delivering a vape shop-based intervention. Themes that were identified were the characteristics of the intervention (duration and timing; delivery; style and content; and product provisions); barriers to the intervention (challenges for new vapers; false information; tobacco company involvement; and conflicts of interest); facilitators to the intervention (positive views on vaping; cost-effectiveness; popularity; and accessibility); and considerations for the intervention (data protection and privacy; aesthetics; and regulation and management). The results suggest that the intervention should be delivered by vape shop workers with mandatory training with the support of SSS. Most stakeholders agreed quitting vaping was not a priority, but that information on how to reduce nicotine use should be given. Concerns around privacy, General Data Protection Regulation, misinformation about vaping, and tobacco company involvement would need to be addressed.

CONCLUSIONS

Stakeholders agree that VS should offer stop smoking interventions and hold similar opinions on how this should be delivered.

IMPLICATIONS

This study suggests that smokers, vapers, and other key stakeholders are positive about the idea of a stop-smoking vape shop-based intervention and that they hold similar opinions on how this should be delivered. Most participants felt that this should be primarily delivered by trained vape shop staff and run with support from SSS. Participants agreed that a stop-smoking vape shop-based intervention should be flexible in terms of the type, duration, and frequency of support provided, and that the intervention should comprise both technical guidance on using a vape and behavioral support to prevent a return to smoking.

Use of tobacco during COVID-19: A qualitative study among medically underserved individuals

The COVID-19 pandemic produced stress for people around the world. The perception that tobacco can be a coping tool for stress relief suggests that the conditions during the COVID-19 pandemic can provide insight into the relationship between stress and tobacco use patterns, particularly among those most at risk for severe COVID-19 disease. The goal was to identify the impacts of the COVID-19 pandemic on tobacco use and preparedness for smoking cessation among individuals who smoke and are older and medically underserved. We conducted in-depth interviews with 39 patients to learn about individuals' smoking behavior during the COVID-19 pandemic. We used a modified grounded theory approach to code and analyze all qualitative data. We conducted thematic analysis to identify key factors associated with smoking behaviors during COVID-19. Our results indicated that increases in perceived stress and social isolation may have been associated with increased tobacco use during the COVID-19 pandemic. Pandemic-related social isolation contributed to increases in smoking, despite respondents being concerned about the severity of COVID-19. While many respondents felt that smoking relieved their stress from the pandemic, they appeared unaware of the stress-inducing properties of tobacco use. Our findings indicate that pandemic-related stress impacted smoking behavior among older, medically underserved smokers. Results may assist clinicians in addressing the role of tobacco use in response to highly stressful events. Smoking cessation strategies should consider the implications of stress on smoking behavior, including smoking relapse in response to highly stressful events-particularly for medically underserved populations.

Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: A randomized controlled trial

BACKGROUND AND AIMS

Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC).

DESIGN, SETTING AND PARTICIPANTS

This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum.

INTERVENTIONS

Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence ('3-month incentives'); or (iii) UC plus '3-month incentives' plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence ('12-month incentives').

MEASUREMENTS

Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance.

SECONDARY OUTCOMES

self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum.

FINDINGS

Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46-3.96), P = 0.001; 12 months versus UC 1.67 (1.04-2.70), P = 0.035; 3 months versus UC 0.69 (0.41-1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis.

CONCLUSIONS

This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care.

Trends in varenicline use for tobacco cessation, and their implications

BACKGROUND

Tobacco use remains a leading cause of death in the U.S. Varenicline is a preferred medication for tobacco cessation, and a prior report in the literature showed its use fell dramatically after the voluntary recall of Chantix (brand) varenicline (name) in July 2021.

OBJECTIVES

Working with data on prescriptions for varenicline and nicotine-replacement therapy (NRT), we studied use from 2018 to 2023 to determine if varenicline use had recovered or if there had been a compensatory increase in NRT use.

METHODS

Data are yearly from state employees and their dependents who were ≥18 years of age and were health-insurance beneficiaries of the Washington Public Employees Benefits Board from July 2018 through June 2023. Data include numbers of tobacco users and numbers of prescriptions filled.

RESULTS

The 5-year prevalence of tobacco use among 224,816 beneficiaries was 4.6%. The percentage of tobacco users who filled a prescription for varenicline fell from highs of 9.5% and 9.6% in the 2018-2019 and 2019-2020 years to lows of 5.3% and 6.4% in the 2021-2022 and 2022-2023 years. For nicotine replacement therapy, prescriptions rose modestly over the 5 years, from 4.5% in 2018-2019% to 6.0% in 2022-2023.

DISCUSSION

Varenicline use dropped after the voluntary recall of Chantix by Pfizer in mid-2021 and has not returned to prerecall levels.

CONCLUSION

Pharmacists and other clinicians should address this drop, in addition to addressing longer-term challenges to increasing varenicline use; these include the requirement for a prescription and the black-box warning by the Food and Drug Administration, rescinded in 2016.

Evaluation of the impact of the COVID-19 pandemic on a smoking cessation service in Derbyshire: An interrupted time series analysis

BACKGROUND

Data published early in the COVID-19 pandemic suggested that smokers infected with SARS-CoV-2 were more likely to need hospital treatment or die than non-smokers, and thus this was seen as a motivator to encourage smokers to make a quit attempt. Live Life Better Derbyshire (LLBD) is an integrated lifestyle service providing free support for residents Derbyshire, UK, who want to quit smoking. On 19 March 2020, LLBD converted from offering face-to-face cessation support to a smoking cessation service delivered remotely.

METHODS

Interrupted time series analysis to investigate the impact of COVID-19, and the shift to remote delivery of smoking cessation support, on the number of smokers who accessed cessation support with LLBD, set a quit date, and self-reported having quit at 4-week follow-up.

RESULTS

11,393 episodes of smoking cessation support were opened with LLBD between 01 January 2018 and 31 December 2021. The weekly count of all outcomes was increasing prior to the date when LLBD converted to remote-only delivery. There was a 20% immediate drop in the number of episodes opened coinciding with this date (IRR 0.88, 95% CI 0.646-0.992) but no change in the number of quit dates set or 4-week quits or the underlying longer-term trends.

CONCLUSIONS

The COVID-19 pandemic, and associated shift to remote delivery of smoking cessation support by LLBD, had no substantial sustained overall impact on measures of smoking cessation service activity and success.

Contingency management for smoking cessation for individuals with overweight or obesity: A randomized controlled trial

BACKGROUND

Interventions for quitting smoking and weight control among individuals with excess weight are scarce. Our study evaluated the effectiveness of cognitive behavioral therapy (CBT) plus contingency management (CM) in this population, and examined whether CM for smoking cessation improved CBT treatment outcomes at end of treatment (EOT) and at 1-, 3-, 6-, and 12-month follow-ups (FU).

METHODS

In an 8-week randomized clinical trial, 120 adults who smoke with overweight or obesity (54.16% females; MBMI = 31.75 ± 4.31) were randomly assigned to CBT for both quitting smoking and weight control (n = 60) or the same treatment plus CM for smoking cessation (n = 60). Outcome variables were compared (i.e., treatment completion, smoking abstinence, weight change and secondary outcomes).

RESULTS

At EOT, the CBT + CM group achieved 78.33% 7-day point-prevalence abstinence rates compared to 61.67% in the CBT group (p = .073), and rates declined over time (12-month FU: 18% vs 12%). Participants who attained abstinence weighed more compared to baseline at EOT (Mkg = 1.07; SD = 1.88) and over time (12-month FU: Mkg = 4.19; SD = 4.31). No differences were found between the two groups in outcome variables.

CONCLUSIONS

Both interventions were effective in promoting abstinence and reducing tobacco use over time. Combining CBT with CM for smoking cessation did not improve treatment outcomes in individuals with overweight or obesity compared to CBT only. Future studies should evaluate whether implementing CM for weight maintenance helps control post-cessation weight gain in this population.

Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation

BACKGROUND

During the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The "Living Well Smokefree" service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach's strengths and weaknesses and explore potential improvements.

METHODS

Conducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an "expansion" approach and complementary analysis.

RESULTS

Overall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in "quantity vs. quality" of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the "cost-per-quit". Improved dissemination of information to support service users in understanding their options for support was suggested.

CONCLUSIONS

The hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes.

Looking at the Data on Smoking and Post-COVID-19 Syndrome-A Literature Review

Long COVID is a recently described entity that is responsible for significant morbidity and that has consequences ranging from mild to life-threatening. The underlying mechanisms are not completely understood, and treatment options are currently limited, as existing data focus more on risk factors and predictors. Smoking has been reported as a risk factor for poor outcomes of acute SARS-CoV-2 infection and seems to also play a role in mediating post-COVID-19 symptoms. We aimed to review relevant work addressing the interaction between smoking and long COVID in order to characterize smoking's role as a risk factor and possibly identify new research directions. Methods: The PubMed/MEDLINE database was searched using the keywords 'smoking', 'long COVID', and 'post-acute COVID' to identify relevant English-language articles published up to October 2023. Results and conclusions: From the 374 initial hits, a total of 36 papers were deemed relevant to the aim of the review. There was significant variability concerning the ways in which tobacco usage was quantified and reported; still, there is compelling evidence linking smoking to an increased risk of developing manifestations of post-acute-COVID disease. Some clinical conditions, such as dyspnea, cardiovascular symptoms, and cognitive or mental-health impairment, seem to be relatively strongly associated with smoking, while the connection between smoking and upper-airway involvement seems less certain. The available data support recommending smoking cessation as a clinical tool for the prevention of long COVID.

A cross-sectional survey of medical and other groups' awareness, perceptions, and willingness to use e-cigarettes during the COVID-19 pandemic

Background

In China, people's perceptions towards electronic cigarettes during Corona Virus Disease 2019 (COVID-19) pandemic compared with pre-pandemic conditions have not been explored. Exploring the perceptions of medical workers regarding e-cigarettes is crucial, as they serve as a trusted source of information and providers of smoking cessation counselling for smokers. This cross-sectional study was designed to explore the awareness and perceptions of e-cigarettes among Chinese medical and other groups in the context of the COVID-19 pandemic.

Methods

A cross-sectional survey was performed using an online, anonymous, and self-administered questionnaire. The questionnaire contained sections for collecting participants' general information and Likert scale questions regarding smoking status, perceptions of e-smoking, attitude, and willingness to use e-cigarettes. The respondents included medical students, clinical doctors, and other occupations. Data analysis was performed using tools such as descriptive analysis, binary logistic regression, and multivariate regression.

Results

A total of 952 people completed the questionnaire, and 96.54% of them reported to have heard about e-cigarettes. The most common source of information about e-cigarettes was advertising. Notably, 28 of the 116 smokers reported that they had used e-cigarettes. Independent-samples T-tests results showed that medical groups believed e-cigarettes contained tar (p = 0.03). Most of the medical and non-medical participants maintained neutral attitudes towards e-cigarette policies (38.3%) and prices (49.2%) but their views were significantly different (p < 0.001). Multivariate logistic regression indicated that highly educated people had higher knowledge about e-cigarettes relative to those with lower education (undergraduate, OR = 1.848, 95CI% = 1.305-2.616, p = 0.001; master's degree or doctoral degree, OR = 1.920, 95CI% = 1.230-2.997, p = 0.004). The medical group used fewer e-cigarettes compared to non-medical group (OR = 1.866, 95CI% = 1.185-2.938, p = 0.007), the non-traditional cigarette users showed lower utilization compared to traditional cigarette users (18-40, OR = 4.797, 95CI% = 0.930-24.744, p = 0.061; > 40, OR = 9.794, 95CI% = 1.683-56.989, p = 0.011) and the older adult used fewer than the young (18-40, OR = 4.797, 95CI% = 0.930-24.744, p = 0.061; > 40, OR = 9.794, 95CI% = 1.683-56.989, p = 0.011).

Conclusion

This study found that individuals tend to hold negative attitudes towards the awareness, perceptions, and willingness to use e-cigarettes. Medical groups are less likely to use e-cigarettes, but misperceptions are still prevalent among them. This calls for additional training for such medical personnel to improve their capacity to provide necessary counselling to smokers. E-cigarettes advertisements were the main source of information for young individuals to learn about e-cigarettes, and hence measures should be taken to restrict exposure of young individuals to e-cigarettes.