Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong

Have we found a solution for health misinformation? A ten-year systematic review of health misinformation literature 2013-2022

BACKGROUND

Health misinformation (HM) has emerged as a prominent social issue in recent years, driven by declining public trust, popularisation of digital media platforms and escalating public health crisis. Since the Covid-19 pandemic, HM has raised critical concerns due to its significant impacts on both individuals and society as a whole. A comprehensive understanding of HM and HM-related studies would be instrumental in identifying possible solutions to address HM and the associated challenges.

METHODS

Following the PRISMA procedure, 11,739 papers published from January 2013 to December 2022 were retrieved from five electronic databases, and 813 papers matching the inclusion criteria were retained for further analysis. This article critically reviewed HM-related studies, detailing the factors facilitating HM creation and dissemination, negative impacts of HM, solutions to HM, and research methods employed in those studies.

RESULTS

A growing number of studies have focused on HM since 2013. Results of this study highlight that trust plays a significant while latent role in the circuits of HM, facilitating the creation and dissemination of HM, exacerbating the negative impacts of HM and amplifying the difficulty in addressing HM.

CONCLUSION

For health authorities and governmental institutions, it is essential to systematically build public trust in order to reduce the probability of individuals acceptation of HM and to improve the effectiveness of misinformation correction. Future studies should pay more attention to the role of trust in how to address HM.

Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study

BACKGROUND

Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention.

OBJECTIVE

This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians.

METHODS

We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter.

RESULTS

In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively.

CONCLUSIONS

Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially "filling the vacuum" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects.

Beliefs in COVID-19 Vaccine Misinformation Among Unvaccinated Black Americans: Prevalence, Socio-Psychological Predictors, and Consequences

Health-related misinformation is a major threat to public health and particularly worrisome for populations experiencing health disparities. This study sets out to examine the prevalence, socio-psychological predictors, and consequences of beliefs in COVID-19 vaccine misinformation among unvaccinated Black Americans. We conducted an online national survey with Black Americans who had not been vaccinated against COVID-19 (N = 800) between February and March 2021. Results showed that beliefs in COVID-19 vaccine misinformation were prevalent among unvaccinated Black Americans with 13-19% of participants agreeing or strongly agreeing with various false claims about COVID-19 vaccines and 35-55% unsure about the veracity of these claims. Conservative ideology, conspiracy thinking mind-set, religiosity, and racial consciousness in health care settings predicted greater beliefs in COVID-19 vaccine misinformation, which were associated with lower vaccine confidence and acceptance. Theoretical and practical implications of the findings are discussed.

Effect of smoking-related COVID-19 risk messaging on smoking cessation in community smokers: A pragmatic randomized controlled trial

INTRODUCTION

Observational and experimental studies have suggested that messaging on smoking-related COVID-19 risk may promote smoking abstinence, but evidence from randomized clinical trials (RCTs) is lacking.

METHODS

This was a pragmatic RCT in Hong Kong, China, to compare the effectiveness of communicating smoking-related COVID-19 risk with generic cessation support on abstinence. Both groups received brief cessation advice at baseline. The intervention group received messaging on smoking-related COVID-19 risk and cessation support via instant messaging for three months (16 messages in total), which highlighted the increased risk of severe COVID-19 and deaths, and potentially higher risk of viral exposure (e.g. due to mask removal) for smokers. The control group received generic text messaging support for three months (16 messages). The primary outcomes were biochemically validated 7-day point prevalence abstinence (PPA) at 3 and 6 months. Intention to treat analyses was used.

RESULTS

Between 13 June and 30 October 2020, 1166 participants were randomly assigned to an intervention (n=583) or control (n=583) group. By intention-to-treat, validated 7-day PPA did not significantly differ between the intervention and control groups at three months (9.6% and 11.8%, relative risk, RR=0.81; 95% CI: 0.58-1.13, p=0.22) or six months (9.3% and 11.7%, RR=0.79; 95% CI: 0.57-1.11, p=0.18). A higher perceived severity of COVID-19 in smokers at baseline was associated with a greater validated 7-day PPA at six months, and a marginally significant intervention effect on changes in perceived severity from baseline through 6 months was found (p for group × time interaction = 0.08).

CONCLUSIONS

Communicating smoking-related COVID-19 risk via instant messaging was not more effective in increasing smoking abstinence than generic cessation support.

TRIAL REGISTRATION

The study is registered on ClinicalTrials.gov Identifier: NCT04399967.

Using the Pan American Health Organization digital conversational agent to educate the public on alcohol use and health: a preliminary analysis

BACKGROUND

Background: There is widespread misinformation about the effects of alcohol consumption on health, which were amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the WHO response during the COVID-19 pandemic to quickly disseminate evidence-based information to the public, related to COVID-19 and tobacco. PAHO seized the opportunity to develop a conversational agent to talk about alcohol related topics and therefore complement traditional forms of health education which have been promoted in the past.

OBJECTIVE

Objective: To develop and deploy a digital conversational agent to interact to an unlimited number of users, 24 hours a day, anonymously, about alcohol topics, in several languages, including on ways to reduce risks from drinking, at no cost and accessible through various devices.

METHODS

Methods: The content development was based on the latest scientific evidence on alcohol impacts on health, social norms about drinking and data from the World Health Organization and PAHO. The agent itself was developed through a non-exclusive license agreement with a private company and included Google Digital Flow ES as the natural language processing software, and AWS for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff.

RESULTS

Results: The conversational agent was named Pahola and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore this was considered not research with human subjects. Pahola speaks in English, Spanish and Portuguese, interacts anonymously to a potential infinite number of users through various digital devices. Users were required to accept terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media, reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1,532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was five minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered.

CONCLUSIONS

Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people.

CLINICALTRIAL

Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence

BACKGROUND

The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.

METHODS

A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.

CONCLUSIONS

This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.

Changes in Smoking Status and Behaviors After the First 10 Months of COVID-19 Pandemic in Indonesia

INTRODUCTION

There remains inconclusive evidence on potential changes in smoking status and behaviors during the coronavirus disease 2019 (COVID-9) pandemic, especially in developing countries.

AIMS AND METHODS

This study explores the direction of changes in smoking status and behaviors after 10 months of the COVID-19 pandemic in Indonesia as well as examining the association between economic shocks and changes in smoking behaviors. Primary data were gathered through a phone survey targeting productive-age mobile-phone users in Indonesia (n = 1082). Descriptive analysis was employed to determine changes in smoking status and behaviors 10 months into the pandemic, while logistic regression analysis was used to investigate how employment shocks, financial strain, COVID-19-related indicators, and demographic characteristics were associated with smoking behaviors of people who continue smoking.

RESULTS

Respondents experiencing changes in smoking status were dominated by people who persistently smoked during the pandemic, while those who quit, relapsed, and started smoking, was extremely small. Nevertheless, a considerable portion of people who continue smoking adjusted their smoking behaviors: 40.3% reduced smoking intensity and 25.3% switched to lower-price cigarettes. Multivariable regression analysis revealed that, among people who continue smoking, those who experienced financial strain during the pandemic had higher odds of reducing smoking intensity, while those who switched to lower job status had higher odds of switching to cheaper cigarettes.

CONCLUSIONS

The research has shown that smoking status and behaviors of people who continue smoking mostly remained unchanged after 10 months of the COVID-19 pandemic. Changes in employment and financial conditions during the pandemic were associated with modified smoking behaviors.

IMPLICATIONS

This study is the first to determine the direction and analyze the factors of changes in smoking during the COVID-19 pandemic in Indonesia. This new understanding should help improve predicting the trends in smoking in future crises or pandemics in developing countries, specifically Indonesia. The discovered patterns on smokers' reaction to an exogenous shock may provide evidence to support tobacco control policies in Indonesia.

Active Smokers Are at Higher Risk of COVID-19 Death: A Systematic Review and Meta-analysis

INTRODUCTION

Current evidence indicates that smoking worsens COVID-19 outcomes. However, when studies restricted their analyses to current smokers, the risks for COVID-19 severity and death are inconsistent.

AIMS AND METHODS

This meta-analysis explored the association between current smoking and the risk for mortality based on the studies that reported all three categories of smoking (current, former, and never smokers) to overcome the limitation of the previous meta-analyses which former smokers might have been classified as nonsmokers. We searched PubMed and Embase up to January 1, 2021. We included studies reporting all three categories of smoking behaviors of COVID-19 patients and mortality outcomes. A random-effects meta-analysis and meta-regression were used to examine relationships in the data.

RESULTS

A total of 34 articles with 35 193 COVID-19 patients was included. The meta-analysis confirmed the association between current smoking (odds ratio [OR] 1.26, 95% confidence interval [CI]: 1.01-1.58) and former smoking (OR 1.76, 95% CI: 1.53-2.03) with COVID-19 mortality. We also found that the risk for COVID-19 death in current smokers does not vary by age, but significantly drops by age in former smokers. Moreover, current smokers in non-high-income countries have higher risks of COVID-19 death compared with high-income countries (OR 3.11, 95% CI: 2.04-4.72 vs. OR 1.14, 95% CI: 0.91-1.43; p = .015).

CONCLUSIONS

Current and former smokers are at higher risk of dying from COVID-19. Tobacco control should be strengthened to encourage current smokers to quit and prevent the initiation of smoking. Public health professionals should take the COVID-19 pandemic as an opportunity to promote smoking prevention and cession.

IMPLICATIONS

This study makes an important contribution to the existing literature by distinguishing between current and former smoking and their separate effects on COVID-19 mortality. We also explore the effects by age of patients and country income level. Findings from this study provide empirical evidence against misinformation about the relationship between smoking and COVID-19 mortality.

Associations of changes in smoking-related practices with quit attempt and smoking consumption during the COVID-19 pandemic: A mixed-methods study

INTRODUCTION

How changes in smoking routine due to COVID-19 restrictions (e.g. refraining from smoking outdoors and stockpiling tobacco products) influence smoking behaviors remains understudied. We examined the associations of changes in smoking-related practices with quit attempts and smoking consumption in current smokers using a mixed-methods design.

METHODS

In a community-based telephone survey conducted between the second and third wave of the COVID-19 pandemic in Hong Kong, 659 smokers (87.1% male; 45.2% aged 40-59 years) were asked about quit attempts and changes in cigarette consumption and five smoking-related practices since the COVID-19 outbreak. Logistic regression was used to calculate adjusted odds ratio (AOR), adjusting for sex, age, education level, chronic disease status, heaviness of smoking (HSI), psychological distress (PHQ-4) and perceived danger of COVID-19. A subsample of 34 smokers provided qualitative data through semi-structured interviews for thematic analyses.

RESULTS

Favorable changes in smoking-related practices, including having avoided smoking on the street (prevalence: 58.9%) and reduced going out to buy cigarettes (33.5%), were associated with a quit attempt (AOR: 2.09 to 2.26; p<0.01) and smoking reduction (AOR: 1.76 to 4.97; p<0.05). Avoiding smoking with other smokers (50.5%) was associated with smoking reduction (AOR=1.76; p<0.05) but not quit attempt (AOR=1.26; p>0.05). Unfavorable changes, including having increased smoking at home (25.0%) and stockpiled tobacco products (19.6%), were associated with increased smoking (AOR: 2.84 to 6.20; p<0.05). Low HSI (0-2) was associated with favorable changes (p<0.01), while high HSI score (3-6) was associated with unfavorable changes (p<0.01). Qualitative interviews revealed a double-edged effect of staying at home on smoking consumption and that pandemic precautionary measures (e.g. mask-wearing) reduced outdoor smoking.

CONCLUSIONS

Amid the pandemic, favorable changes in smoking-related practices in smokers were mostly associated with quit attempts and smoking reduction, while unfavorable changes were associated with increased smoking. Smokers with higher nicotine dependence were more negatively impacted.

The development of the Pan American Health Organization digital health specialist on alcohol use

Introduction

On 19 November 2021 the Pan American Health Organization (PAHO) developed and deployed the first-ever digital health worker dedicated to alcohol-related topics, named Pahola. This paper describes this developmental process and the first results of its uptake and interactions with the public.

Methods

PAHO secured a non-exclusive worldwide license with a technology company to use their Human OS ecosystem, which enables human-like interactions between digital people and users via an application. Google Digital flow ES was used to develop the conversations of Pahola on topics related to alcohol and health, screening of alcohol risk using the AUDIT and providing a quit/cut back plan to users, along with additional treatment services and resources in each country of the Americas. A communication campaign was also implemented from launching date until 31 December 2021.

Results

Pahola attracted good attention from the media, and potentially reached 1.6 million people, leading to 236,000 sessions on its landing page, mostly through mobile devices. The average time people effectively spent talking to Pahola was five minutes. Major dropouts were observed in different steps of the conversation flow.

Discussion

Pahola was quickly able to connect to a large worldwide population with reliable alcohol information. It could potentially increase the delivery of SBI and improve alcohol health literacy. However, its preliminary results pointed to much needed changes to its corpus and on its accessibility, which are being currently implemented.

The COVID‑19 pandemic and the consumption of tobacco and nicotine-containing products: a literature review

The fight against the COVID‑19 pandemic has led to the implementation of unprecedented measures in countries, including self-isolation, which have had a significant impact on people’s behavior and could lead to a change in the consumption of tobacco and nicotine-containing products. This article provides an overview of studies evaluating smoking behavior change and its impact on the prevalence of tobacco and nicotine use in the community at the start of the pandemic.

Methods. The review included 31 published studies with data on smoking from more than 250,000 people from 24 countries that examined the following aspects of the problem: the association of smoking with COVID‑19 outcomes, identification of factors influencing smoking behavior at the beginning of the COVID‑19 pandemic, changing prevalence of tobacco and nicotine consumption at the start of the COVID‑19 pandemic, tobacco company actions during the pandemic, impact of misinformation about the association of smoking with COVID‑19 on consumers of tobacco and nicotine products, government actions to reduce the sale of tobacco and nicotine products during the pandemic time.

Findings. All researchers identified mixed responses from consumers of tobacco and nicotine-containing products early in the pandemic. In equal proportions, smokers increased their tobacco/nicotine intake or reduced their smoking intensity. To a lesser extent, consumers quit smoking, but there were respondents who reported starting smoking due to the COVID‑19 pandemic.

Conclusion. Monitoring the prevalence of consumption of tobacco and nicotine-containing products and the causes influencing it in the early periods of the COVID‑19 pandemic made it possible to identify additional effective measures, the implementation of which can prevent the growth of tobacco and nicotine consumption in such situations.

Charming e-cigarette users with distorted science: a survey examining social media platform use, nicotine-related misinformation and attitudes towards the tobacco industry

OBJECTIVE

To examine the role of social media in promoting recall and belief of distorted science about nicotine and COVID-19 and whether recall and belief predict tobacco industry beliefs.

DESIGN

Young adults aged 18-34 years (N=1225) were surveyed cross-sectionally via online Qualtrics panel. The survey assessed recall and belief in three claims about nicotine and COVID-19 and three about nicotine in general followed by assessments of industry beliefs and use of social media. Ordinal logistic regression with robust standard errors controlling for gender, race/ethnicity, education, current e-cigarette use and age was used to examine relationships between variables.

RESULTS

Twitter use was associated with higher odds of recall (OR=1.21, 95% CI=1.01 to 1.44) and belief (OR=1.26, 95% CI=1.04 to 1.52) in COVID-19-specific distorted science. YouTube use was associated with higher odds of believing COVID-19-specific distorted science (OR=1.32, 95% CI=1.09 to 1.60). Reddit use was associated with lower odds of believing COVID-19-specific distorted science (OR=0.72, 95% CI=0.59 to 0.88). Recall (OR=1.26, 95% CI=1.07 to 1.47) and belief (OR=1.28, 95% CI=1.09 to 1.50) in distorted science about nicotine in general as well as belief in distorted science specific to COVID-19 (OR=1.61, 95% CI=1.34 to 1.95) were associated with more positive beliefs about the tobacco industry. Belief in distorted science about nicotine in general was also associated with more negative beliefs about the tobacco industry (OR=1.18, 95% CI=1.02 to 1.35).

CONCLUSIONS

Use of social media platforms may help to both spread and dispel distorted science about nicotine. Addressing distorted science about nicotine is important, as it appears to be associated with more favourable views of the tobacco industry which may erode public support for effective regulation.

Smoking in Patients With Chronic Cardiovascular Disease During COVID-19 Lockdown

Objectives

This cross-sectional study aims to investigate health-related behaviors including tobacco consumption among patients with cardiovascular diseases (CVD), during the first COVID-19-related lockdown.

Methods

After 5 weeks of COVID-19 lockdown, 220 patients with chronic coronary syndromes (CCS) and 124 with congestive heart failure (CHF) answered a phone questionnaire.

Results

Among these 344 patients, 43 (12.5%) were current smokers, and none had quit during the lockdown. When compared with non-smokers, smokers were 15 years younger, more often diabetic, more likely to live in an urban than a rural lockdown location, and more often in the CCS cohort (p = 0.011). Smokers described greater psychological impairment, but their rates of decrease in physical activity and of increase in screen time were similar to non-smokers. More than one-third (13/43) increased their tobacco consumption, which was mainly related to stress or boredom, but not driven by media messages on a protective effect of nicotine.

Conclusions

During the first COVID-19 lockdown, we found a decrease in favorable lifestyle behaviors among patients with CVD. Strikingly, one-third of smokers with CCS or CHF increased their tobacco consumption. Given the major impact of persistent smoking in patients with CVD, this highlights the need for targeted prevention strategies, in particular during such periods.

Changes in cigarette and e-cigarette use among US young adults from before to during the COVID-19 pandemic: News exposure and risk perceptions as potential predictors

INTRODUCTION

COVID-19 impacted cigarette and e-cigarette use behaviors among some individuals. This study examined COVID-19 factors and prior substance use as predictors of cigarette and e-cigarette cessation and initiation among US young adults from before to during the COVID-19 pandemic.

METHODS

We analyzed data from Wave 3 (Sept-Dec 2019) and Wave 5 (Sept-Dec 2020) of a 2-year, 5-wave longitudinal study of young adults across six US metropolitan areas. We examined COVID-19 news exposure, perceived smoking and e-cigarette use risk, and prior substance use, as predictors of cigarette and e-cigarette cessation and initiation, respectively.

RESULTS

Of W3 cigarette users (n=516), 37.8% (n=195) quit cigarettes at W5; predictors of cessation included younger age, fewer days of W3 past-month cigarette use, and no W3 e-cigarette use. Of W3 e-cigarette users (n=687), 38.7% (n=266) quit e-cigarettes at W5; predictors included greater COVID-19 news exposure, fewer days of W3 past-month e-cigarette use, and no W3 cigarette use. Of W3 cigarette non-users (n=1693), 5.0% (n=85) initiated cigarettes at W5; predictors of initiation included younger age, lower perceived smoking risk, lifetime cigarette and e-cigarette use, and W3 e-cigarette use. Of W3 e-cigarette non-users (n=1522), 6.3% (n=96) initiated e-cigarettes at W5; predictors included younger age, less news exposure, lifetime cigarette and e-cigarette use, and W3 cigarette use.

CONCLUSIONS

These findings underscore the need to address cigarette and e-cigarette co-use and related risk perceptions in prevention and cessation interventions.

Understanding the Impact of COVID-19 on Tobacco and Nicotine Use among Young Adults Identified as Sexual and Gender Minorities: A Mixed Methods Approach

We investigated the perceived impact of COVID-19 on changes in tobacco and nicotine (NT) use among sexual and gender minority (SGM) young adults. We used a mixed methods approach that included closed- and open-ended survey questions and in-depth interviews. Participants were 53 SGM young adults in California who reported current or past cigarette smoking. Of study participants, 63% (n=33) reported any changes in their NT use, and of those, 60% reported initial increase of NT use. Content analysis of an open-ended survey question revealed three reported reasons for changes in NT use: (1) changes in routine activities (27%), (2) stress (46%), and (3) health (24%). Thematic analysis of qualitative interviews identified several related themes: (1) in discussions of increased NT use, stress and boredom/free time were important aspects of changes to daily routines, (2) fluctuations in NT use behaviors occurred over time, (3) reasons for NT changes were multiple and intertwined, and (4) NT use changes were shaped by experiences related to intersectional forms of structural and social stigmatization. Results reveal the dynamic and complex ways in which participants described their pandemic-related changes in NT use-nuance that is crucial for compassionate and participant-centered approaches to tobacco prevention and cessation.

Substance, use in relation to COVID-19: A scoping review

Background

We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates.

Methods

A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only.

Results

Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use.

Conclusions

Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic.

Funding

Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.

Generalized anxiety disorder during COVID-19 in Canada: Gender-specific association of COVID-19 misinformation exposure, precarious employment, and health behavior change

BACKGROUND

Growing evidence has demonstrated the mental health sequelae of the COVID-19 pandemic. Few studies have examined how pandemic-related stressors and resilience factors of anxiety affect women and men differently in Canada.

METHODS

Population-based data from the Canadian Perspective Survey Series (CPSS-4: July 20 to 26, 2020) were analyzed to examine the relationship between Generalized Anxiety Disorder-7 scale (GAD-7) with COVID-19 misinformation exposure, precarious employment, and health behavior changes, after adjusting for socio-demographic variables. Stratified by gender, two multinomial logistic regression were conducted to calculate the likelihood of having minimal-mild anxiety (1≤ GAD score <10) and moderate-severe anxiety (GAD score ≥10), compared to no anxiety symptoms (GAD=0).

RESULTS

Overall, respondents (n = 3,779) were mainly Canadian-born (76.3%), aged >25 years (85.4%) and high school graduate (87.9%). The population prevalence of moderate-severe GAD was 13.6%, with women significantly higher than men (17.2% vs. 9.9%, p<0.001). For women (n = 2,016), GAD was associated with being absent from work due to COVID-19 reasons (OR=3.52, 99% CI:1.12-11.04), younger age (ORs range from 2.19 to 11.01, p's<0.01), being single/widowed (OR=2.26, 99% CI 1.18-4.33), no past-week contacts outside household (OR=2.81, 99% CI:1.24-6.37), no outdoor exercise (OR=1.86, 99% CI:1.13-3.07). For men (n = 1,753), GAD was associated with frequent fake news exposure (dose-response relations: ORs range from 3.14 to 6.55, p's<0.01), increased time of watching TV (OR=2.62, 99% CI: 1.31 - 5.27), no indoor exercise (OR=1.91, 99% CI:1.07-3.42). For both genders, GAD was associated with increased intake of alcohol, cannabis, and junk/sweet food (p's<0.01).

LIMITATIONS

Cross-sectional data prohibits causal inferences; self-reporting biases of GAD symptoms requires confirmation with diagnostic records.

CONCLUSION

The gendered impact of the COVID-19 pandemic was observed in the associations between clinically significant anxiety with COVID-19 misinformation exposure, job precarity, and addictive behaviors in Canada. Mental health interventions need to be gender responsive and should tackle upstream social determinants of health in this public health emergency.

Changes in tobacco use at the early stage of the COVID-19 pandemic: Results of four cross-sectional surveys in Hong Kong

INTRODUCTION

Changes in tobacco use since the COVID-19 outbreak differed by countries and little is known about changes in the use of specific tobacco products.

METHODS

We analyzed data from four cross-sectional telephone/online surveys from April to June 2020 to investigate such changes since the 1st and 2nd wave outbreaks (February to April 2020) in Hong Kong. The respondents were 1595 adults (83.2% male) who used tobacco before the COVID-19 outbreak from our previous intervention study and surveys. We investigated the changes in tobacco use, intention to quit and quit attempts during the outbreak.

RESULTS

About two-thirds (65.3%) of respondents reported no change in overall tobacco use, while 23.1% used less (including cessation) and 11.6% used more, resulting in a net decrease of 11.5 percentage points. A greater net decrease was observed for cigarettes (14.3% points) than heated tobacco products (HTPs, 3.3% points) and electronic cigarettes (e-cigarettes, 2.5% points). Decreased use was mainly due to the more extended stay at home (63.2%), health considerations (52.6%) and mask-wearing (47.4%), while increased use was for passing time (75.0%) and releasing stress (46.4%). Eight percent of cigarette, HTP and e-cigarette users reported a higher intention to quit since the pandemic outbreak. Nineteen percent of tobacco users (176/948) attempted to quit during the pandemic. Only 2.9% (46/1569) were abstinent at the time of the survey.

CONCLUSIONS

Overall tobacco use decreased after the first two waves of the COVID-19 outbreak in Hong Kong. A greater proportion of cigarette users decreased use than HTP and e-cigarette users. Given the different methods used in the four surveys, future studies should aim for a large and representative sample.

The usefulness of a checklist approach-based confirmation scheme in identifying unreliable COVID-19-related health information: a case study in Japan

Consumers are increasingly able to easily access health information online about food products. However, consumers have difficulty identifying reliable health information from diverse sources along with information about the coronavirus disease (COVID-19) pandemic because the inundation of information (both true and false) overwhelm consumers. We investigated the usefulness of a checklist confirmation scheme for identifying unreliable COVID-19-related health information. Data were collected from June 30-July 1, 2021. First, we measured 700 participants' baseline health literacy levels by having them read unreliable health information about the efficacy of green tea intake in preventing COVID-19 based on the results of animal experimentation. Second, participants read an explanation with a five-step flowchart of how to identify reliable health information. Thereafter, we remeasured participants' health literacy levels. To identify the factors hindering the effect of the confirmation scheme, a logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 77.9% (293/376) of those with low health literacy levels at baseline still had low literacy after the intervention. The factor that hindered the confirmation scheme's usefulness was benefit perceptions of food ingredients (OR: 0.493; 95% CI: 0.252-0.966). Consumers with higher benefit perceptions of a target product faced more difficulties using the confirmation scheme effectively. Therefore, the most effective strategies involve filtering information at the organizational level rather than the individual level, which should help consumers correctly identify misinformation concerning food and health and promote accurate decision-making.

Tracking Private WhatsApp Discourse About COVID-19 in Singapore: Longitudinal Infodemiology Study

BACKGROUND

Worldwide, social media traffic increased following the onset of the COVID-19 pandemic. Although the spread of COVID-19 content has been described for several social media platforms (eg, Twitter and Facebook), little is known about how such content is spread via private messaging platforms, such as WhatsApp (WhatsApp LLC).

OBJECTIVE

In this study, we documented (1) how WhatsApp is used to transmit COVID-19 content, (2) the characteristics of WhatsApp users based on their usage patterns, and (3) how usage patterns link to COVID-19 concerns.

METHODS

We used the experience sampling method to track day-to-day WhatsApp usage during the COVID-19 pandemic. For 1 week, participants reported each day the extent to which they had received, forwarded, or discussed COVID-19 content. The final data set comprised 924 data points, which were collected from 151 participants.

RESULTS

During the weeklong monitoring process, most participants (143/151, 94.7%) reported at least 1 COVID-19-related use of WhatsApp. When a taxonomy was generated based on usage patterns, around 1 in 10 participants (21/151, 13.9%) were found to have received and shared a high volume of forwarded COVID-19 content, akin to super-spreaders identified on other social media platforms. Finally, those who engaged with more COVID-19 content in their personal chats were more likely to report having COVID-19-related thoughts throughout the day.

CONCLUSIONS

Our findings provide a rare window into discourse on private messaging platforms. Such data can be used to inform risk communication strategies during the pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04367363; https://clinicaltrials.gov/ct2/show/NCT04367363.

COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users

Novel mRNA vaccines have been developed and were first distributed to high-risk individuals (including smokers) in the United States starting in December 2020 to combat the coronavirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at least 1 dose of a COVID-19 vaccine, but many others have reported hesitation about becoming vaccinated. We examined COVID-19 vaccine uptake and hesitancy from a convenience sample of Pennsylvanian adult smokers in April 2021, approximately 3 months after tobacco users were eligible to receive vaccination in the state. Participants (n = 231) were 23.4% male, 90.5% white, and had a mean age of 48.1 (SD = 11.9) years. All participants were current tobacco users, with the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD = 8.1) cigarettes smoked per day. Nearly 60% (n = 137) reported receiving at least 1 dose of the vaccine and of those who did not (n = 94), 84% (n = 79) said they were somewhat or very unlikely to get a vaccine. Those who were unvaccinated were more likely to not consume news about COVID-19 (chi-square P-value < .01) and less likely to believe government news sources as reliable information for COVID-19 (chi-square P-value < .01). Qualitative responses among those who were vaccine hesitant expressed concerns about the lack of research on the vaccine, distrust of the safety of the vaccine, and fears about side effects. Understanding vaccine hesitancy among tobacco users can help develop targeted communication strategies and directly address concerns to promote vaccination among this population who may be at an increased risk of severe complications from COVID-19.

Debunking Health Misinformation on Social Media: The Challenge of Dynamic Conversations (Preprint)

Background

The spread of false and misleading health information on social media can cause individual and social harm. Research on debunking has shown that properly designed corrections can mitigate the impact of misinformation, but little is known about the impact of correction in the context of prolonged social media debates. For example, when a social media user takes to Facebook to make a false claim about a health-related practice and a health expert subsequently refutes the claim, the conversation rarely ends there. Often, the social media user proceeds by rebuking the critic and doubling down on the claim.

Objective

The aim of this study was to examine the impact of such extended back and forth between false claims and debunking attempts on observers’ dispositions toward behavior that science favors. We tested competing predictions about the effect of extended exposure on people’s attitudes and intentions toward masking in public during the early days of the COVID-19 pandemic and explored several psychological processes potentially underlying this effect.

Methods

A total of 500 US residents took part in an online experiment in October 2020. They reported on their attitudes and intentions toward wearing masks in public. They were then randomly assigned to one of four social media exposure conditions (misinformation only vs misinformation+correction vs misinformation+correction+rebuke vs misinformation+correction+rebuke+second correction), and reported their attitudes and intentions for a second time. They also indicated whether they would consider sharing the thread if they were to see it on social media and answered questions on potential mediators and covariates.

Results

Exposure to misinformation had a negative impact on attitudes and intentions toward masking (β=–.35, 95% CI –.42 to –.29; P<.001). Moreover, initial debunking of a false claim generally improved attitudes and intentions toward masking (β=.35, 95% CI .16 to .54; P<.001). However, this improvement was washed out by further exposure to false claims and debunking attempts (β=–.53, 95% CI –.72 to –.34; P<.001). The latter result is partially explained by a decrease in the perceived objectivity of truth. That is, extended exposure to false claims and debunking attempts appear to weaken the belief that there is an objectively correct answer to how people ought to behave in this situation, which in turn leads to less positive reactions toward masking as the prescribed behavior.

Conclusions

Health professionals and science advocates face an underappreciated challenge in attempting to debunk misinformation on social media. Although engaging in extended debates with science deniers and other purveyors of bunk appears necessary, more research is needed to address the unintended consequences of such engagement.

The causes, impacts and countermeasures of COVID-19 "Infodemic": A systematic review using narrative synthesis

An unprecedented infodemic has been witnessed to create massive damage to human society. However, it was not thoroughly investigated. This systematic review aims to (1) synthesize the existing literature on the causes and impacts of COVID-19 infodemic; (2) summarize the proposed strategies to fight with COVID-19 infodemic; and (3) identify the directions for future research. A systematic literature search following the PRISMA guideline covering 12 scholarly databases was conducted to retrieve various types of peer-reviewed articles that reported causes, impacts, or countermeasures of the infodemic. Empirical studies were assessed for risk of bias using the Mixed-Methods Appraisal Tool. A coding theme was iteratively developed to categorize the causes, impacts, and countermeasures found from the included studies. Social media usage, low level of health/eHealth literacy, and fast publication process and preprint service are identified as the major causes of the infodemic. Besides, the vicious circle of human rumor-spreading behavior and the psychological issues from the public (e.g., anxiety, distress, fear) emerges as the characteristic of the infodemic. Comprehensive lists of countermeasures are summarized from different perspectives, among which risk communication and consumer health information need/seeking are of particular importance. Theoretical and practical implications are discussed and future research directions are suggested.

High Perceived Susceptibility to and Severity of COVID-19 in Smokers Are Associated with Quitting-Related Behaviors

A growing body of evidence shows smoking is a risk factor for coronavirus disease (COVID-19). We examined the associations of quitting-related behaviors with perceived susceptibility to and severity of COVID-19 in smokers. We conducted a telephone survey of 659 community-based adult smokers (81.7% male) in Hong Kong, where there was no lockdown. Exposure variables were perceptions that smoking can increase the risk of contracting COVID-19 (perceived susceptibility) and its severity if infected (perceived severity). Outcome variables were quit attempts, smoking reduction since the outbreak of the pandemic, and intention to quit within 30 days. Covariates included sex, age, education, heaviness of smoking, psychological distress, and perceived danger of COVID-19. High perceived susceptibility and severity were reported by 23.9% and 41.7% of participants, respectively. High perceived susceptibility was associated with quit attempts (prevalence ratio (PR) 2.22, 95% CI 1.41–3.49), smoking reduction (PR 1.75, 95% CI 1.21–2.51), and intention to quit (PR 2.31, 95% CI 1.40–3.84). Perceived severity of COVID-19 was associated with quit attempts (PR 1.64, 95% CI 1.01–2.67) but not with smoking reduction or intention to quit. To conclude, the perceived susceptibility to and severity of COVID-19 in smokers were associated with quitting-related behaviors in current smokers, which may have important implications for smoking cessation amid the pandemic.

Twitter discourse on nicotine as potential prophylactic or therapeutic for COVID-19

Background

An unproven “nicotine hypothesis” that indicates nicotine's therapeutic potential for COVID-19 has been proposed in recent literature. This study is about Twitter posts that misinterpret this hypothesis to make baseless claims about benefits of smoking and vaping in the context of COVID-19. We quantify the presence of such misinformation and characterize the tweeters who post such messages.

Methods

Twitter premium API was used to download tweets (n = 17,533) that match terms indicating (a) nicotine or vaping themes, (b) a prophylactic or therapeutic effect, and (c) COVID-19 (January-July 2020) as a conjunctive query. A constraint on the length of the span of text containing the terms in the tweets allowed us to focus on those that convey the therapeutic intent. We hand-annotated these filtered tweets and built a classifier that identifies tweets that extrapolate the nicotine hypothesis to smoking/vaping with a positive predictive value of 85%. We analyzed the frequently used terms in author bios, top Web links, and hashtags of such tweets.

Results

21% of our filtered COVID-19 tweets indicate a vaping or smoking-based prevention/treatment narrative. Qualitative analyses show a variety of ways therapeutic claims are being made and tweeter bios reveal pre-existing notions of positive stances toward vaping.

Conclusion

The social media landscape is a double-edged sword in tobacco communication. Although it increases information reach, consumers can also be subject to confirmation bias when exposed to inadvertent or deliberate framing of scientific discourse that may border on misinformation. This calls for circumspection and additional planning in countering such narratives as the COVID-19 pandemic continues to ravage our world. Our results also serve as a cautionary tale in how social media can be leveraged to spread misleading information about tobacco products in the wake of pandemics.

Twitter Discourse on Nicotine as Potential Prophylactic or Therapeutic for COVID-19

Background:

An unproven “nicotine hypothesis” that indicates nicotine’s therapeutic potential for COVID-19 has been proposed in recent literature. This study is about Twitter posts that misinterpret this hypothesis to make baseless claims about benefits of smoking and vaping in the context of COVID-19. We quantify the presence of such misinformation and characterize the tweeters who post such messages.

Methods:

Twitter premium API was used to download tweets (n = 17,533) that match terms indicating (a) nicotine or vaping themes, (b) a prophylactic or therapeutic effect, and (c) COVID-19 (January-July 2020) as a conjunctive query. A constraint on the length of the span of text containing the terms in the tweets allowed us to focus on those that convey the therapeutic intent. We hand-annotated these filtered tweets and built a classifier that identifies tweets that extrapolate the nicotine hypothesis to smoking/vaping with a positive predictive value of 85%. We analyzed the frequently used terms in author bios, top Web links, and hashtags of such tweets.

Results:

21% of our filtered COVID-19 tweets indicate a vaping or smoking-based prevention/treatment narrative. Qualitative analyses show a variety of ways therapeutic claims are being made and tweeter bios reveal pre-existing notions of positive stances toward vaping.

Conclusion:

The social media landscape is a double-edged sword in tobacco communication. Although it increases information reach, consumers can also be subject to confirmation bias when exposed to inadvertent or deliberate framing of scientific discourse that may border on misinformation. This calls for circumspection and additional planning in countering such narratives as the COVID-19 pandemic continues to ravage our world. Our results also serve as a cautionary tale in how social media can be leveraged to spread misleading information about tobacco products in the wake of pandemics.

US Physicians' and Nurses' Motivations, Barriers, and Recommendations for Correcting Health Misinformation on Social Media: Qualitative Interview Study

BACKGROUND

Health misinformation is a public health concern. Various stakeholders have called on health care professionals, such as nurses and physicians, to be more proactive in correcting health misinformation on social media.

OBJECTIVE

This study aims to identify US physicians' and nurses' motivations for correcting health misinformation on social media, the barriers they face in doing so, and their recommendations for overcoming such barriers.

METHODS

In-depth interviews were conducted with 30 participants, which comprised 15 (50%) registered nurses and 15 (50%) physicians. Qualitative data were analyzed by using thematic analysis.

RESULTS

Participants were personally (eg, personal choice) and professionally (eg, to fulfill the responsibility of a health care professional) motivated to correct health misinformation on social media. However, they also faced intrapersonal (eg, a lack of positive outcomes and time), interpersonal (eg, harassment and bullying), and institutional (eg, a lack of institutional support and social media training) barriers to correcting health misinformation on social media. To overcome these barriers, participants recommended that health care professionals should receive misinformation and social media training, including building their social media presence.

CONCLUSIONS

US physicians and nurses are willing to correct health misinformation on social media despite several barriers. Nonetheless, this study provides recommendations that can be used to overcome such barriers. Overall, the findings can be used by health authorities and organizations to guide policies and activities aimed at encouraging more health care professionals to be present on social media to counteract health misinformation.

Development and evaluation of air pollution-linked quality of life (AP-QOL) questionnaire: insight from two different cohorts

In this study, the air pollution-related quality of life (AP-QOL) questionnaire was carried out in two geographically and economically different groups including New Delhi (Megacity) and Hamirpur, Himachal Pradesh (town), and APE scores were linked with respiratory and cardiovascular illness. The APE-Score was developed by AP-QOL questionnaire responses using Delphi technique and further analyzed using principal component analysis (PCA). For reliability of APE-Score and AP-QOL questionnaire, α-Cronbach's test and basic statistics were performed. The linear mixed-effect model and odds ratios were used to evaluate air pollution exposure and health outcomes. Overall, 720 academicians and 276 security guards were invited to participate in the questionnaire. Cronbach's α coefficients ranged from 0.70 to 0.84 indicated significant reliability in the AP-QOL questionnaire conducted in this study. Substantial variation in respiratory symptoms and their medical history were found - 76.9% ([95% confidential interval (CI)]: (- 83.8, - 66.9) (p < 0.05)) and - 28.6% (95% CI: (- 37.8, - 18.0) (p < 0.05)), respectively, with interquartile range (IQR) increase of APE score. The odds ratios (ORs) of respiratory medical history (MH Res.) showed a significant increase from 1.01 to 1.35 for low to high air pollution exposure in the academic group of IIT Delhi. Interestingly, for an academic group of NITH, the ORs for medical history of cardiovascular (MH Card.) showed an increase from 1.08 to 1.13 for low to high APE which was not the case for IIT Delhi academicians.

Effects of the COVID-19 pandemic and lockdown on alcohol use disorders and complications

PURPOSE OF REVIEW

To understand the effect of COVID-19 pandemic and lockdown on persons with alcohol use disorders.

RECENT FINDINGS

From a total of 455 titles on COVID-19 and alcohol, 227 abstracts were screened, and 95 articles were reviewed (on November 25th, 2020). The immediate effect was an increase in alcohol related emergencies including alcohol withdrawal, related suicides, and methanol toxicity. Although there are mixed findings with respect to changes in the quantity of drinking, there are reports of binge/heavy drinking during the lockdown as well as relapse postlockdown. Psychological, social, biological, economic and policy-related factors appear to influence the changes in drinking. Although preliminary data suggest no change in alcohol use among persons with comorbid mental illness, findings in this population are presently limited. Among patients with alcohol related liver disease, outcomes appear worse and caution is warranted with the use of medications. Alcohol also appears to increases the risk of COVID-19 infection and complicates its course.Although some nations banned alcohol sales completely during lockdown, others declared it as an essential commodity, resulting in different problems across countries. Alcohol use has added to the burden of the problem particularly among vulnerable groups like the adolescents, elderly, patients with cancer, as well as health professionals. Services for patients with alcohol use disorders have been affected.

SUMMARY

The COVID-19 pandemic has had considerable impact on alcohol use, with an increase in alcohol related emergencies, changes in alcohol use patterns, increased risk of contracting COVID-19, effect on alcohol policies and sales, and an effect on vulnerable groups. It is essential to understand and respond to the current situation, intervene early, and prevent further repercussions of the pandemic.Video abstract link: https://drive.google.com/file/d/1IJWtIs6e554PryKWhdma4VB--mjSZq1C/view?usp=sharing.

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

BACKGROUND

In April 2020, the Japanese government declared a state of emergency due to the COVID-19 pandemic, and infection control measures, including requests to work from home and stay-at-home restrictions, were introduced. This study examined changes in smoking behavior during the COVID-19 state of emergency.

METHODS

An online cross-sectional survey was conducted in Osaka, Japan. To assess differences in smoking behavior among 5,120 current smokers before and after the declaration of a state of emergency, prevalence ratios (PRs) for two outcomes, increased smoking and quitting smoking, were calculated using multivariable Poisson regression, adjusting for potential covariates.

RESULTS

We found 32.1% increased the number of cigarettes smoked and 11.9% quit smoking. After adjustment for all variables, we found risk factors for COVID-19 (men and older age group) had both significantly higher PR for quitting smoking (men: PR 1.38; 95% confidence interval [CI], 1.17-1.62) and participants aged ≥65 years: PR 2.45; 95% CI, 1.92-3.12) and significantly lower PR of increased smoking (men: PR 0.85; 95% CI, 0.78-0.93 and participants ≥65 years: PR 0.38; 95% CI, 0.29-0.49). Additionally, respondents working from home or living alone had significantly higher PR for increased smoking (working from home: PR 1.29; 95% CI, 1.17-1.41 and living alone: PR 1.23; 95% CI, 1.10-1.38) and respondents who changed from cigarettes to heated tobacco products (HTPs) had significantly lower PR for quitting smoking (PR 0.150; 95% CI, 0.039-0.582).

CONCLUSIONS

We suggest people who have high-risk factors for COVID-19 might change their smoking behavior for the better, while people who work from home or live alone might change their smoking behavior for the worse, during the COVID-19 state of emergency. Additionally, changing from smoking cigarettes to using HTPs makes smokers less likely to quit.

Prevalence and determinants of SARS-CoV-2 vaccine hesitancy in Hong Kong: A population-based survey

Background

Although vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most desired solution to end the coronavirus disease (COVID-19) pandemic, there are growing concerns that vaccine hesitancy would undermine its potential. We examined the intention to receive vaccination against SARS-CoV-2 and the associated factors in a representative sample of Chinese adults in Hong Kong.

Methods

We did a dual-frame (landline and mobile) cross-sectional survey of a random sample of 1501 Hong Kong residents aged 18 years or older (53.6% females) in April 2020. We collected data on the intention to receive SARS-CoV-2 vaccine when it becomes available (yes/ no/ undecided), knowledge and perceptions of COVID-19, smoking, alcohol drinking, and sociodemographic factors. Prevalence estimates were weighted by the sex, age, and education of the general population of Hong Kong.

Results

Overall, 45.3% (95% CI: 42.3–48.4%) of the participants had intentions to vaccinate against SARS-CoV-2 when it becomes available, 29.2% (26.5–32.1%) were undecided, and 25.5% (22.9–28.2%) had no intention. The most common reason for vaccine hesitancy (undecided or no intention) was safety concerns (56.5%). Multivariable partial proportional odds model showed higher vaccine hesitancy in males, younger adults, those with no chronic disease, current smokers, and non-alcohol drinkers. After adjusting for sociodemographic and other factors, inadequate knowledge of SARS-CoV-2 transmission (adjusted ORs ranged from 1.27 to 2.63; P < 0.05) and lower perceived danger of COVID-19 (adjusted ORs ranged from 1.62 to 2.47; P < 0.001) were significantly associated with vaccine hesitancy.

Conclusions

In a representative sample of Chinese adults in Hong Kong, only 45.3% of the participants intended to vaccinate against SARS-CoV-2 when available. Vaccine hesitancy was associated with inadequate knowledge about SARS-CoV-2 transmission and lower perceived danger of COVID-19, which needed to be addressed to improve vaccination uptake.

Alcohol Consumption Is Associated with Poor Prognosis in Obese Patients with COVID-19: A Mendelian Randomization Study Using UK Biobank

BACKGROUND

Acute and chronic alcohol abuse has adverse impacts on both the innate and adaptive immune response, which may result in reduced resistance to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and promote the progression of coronavirus disease 2019 (COVID-19). However, there are no large population-based data evaluating potential causal associations between alcohol consumption and COVID-19.

METHODS

We conducted a Mendelian randomization study using data from UK Biobank to explore the association between alcohol consumption and risk of SARS-CoV-2 infection and serious clinical outcomes in patients with COVID-19. A total of 12,937 participants aged 50-83 who tested for SARS-CoV-2 between 16 March to 27 July 2020 (12.1% tested positive) were included in the analysis. The exposure factor was alcohol consumption. Main outcomes were SARS-CoV-2 positivity and death in COVID-19 patients. We generated allele scores using three genetic variants (rs1229984 (Alcohol Dehydrogenase 1B, ADH1B), rs1260326 (Glucokinase Regulator, GCKR), and rs13107325 (Solute Carrier Family 39 Member 8, SLC39A8)) and applied the allele scores as the instrumental variables to assess the effect of alcohol consumption on outcomes. Analyses were conducted separately for white participants with and without obesity.

RESULTS

Of the 12,937 participants, 4496 were never or infrequent drinkers and 8441 were frequent drinkers. Both logistic regression and Mendelian randomization analyses found no evidence that alcohol consumption was associated with risk of SARS-CoV-2 infection in participants either with or without obesity (All q > 0.10). However, frequent drinking, especially heavy drinking (HR = 2.07, 95%CI 1.24-3.47; q = 0.054), was associated with higher risk of death in patients with obesity and COVID-19, but not in patients without obesity. Notably, the risk of death in frequent drinkers with obesity increased slightly with the average amount of alcohol consumed weekly (All q < 0.10).

CONCLUSIONS

Our findings suggest that alcohol consumption has adverse effects on the progression of COVID-19 in white participants with obesity, but was not associated with susceptibility to SARS-CoV-2 infection.

Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study

Background

eHealth literacy can potentially facilitate web-based information seeking and taking informed measures.

Objective

This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors.

Methods

The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated.

Results

The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score.

Conclusions

Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic.

Are smokers protected against SARS-CoV-2 infection (COVID-19)? The origins of the myth

A number of recent studies have found low percentages of smokers among COVID-19 patients, causing scientists to conclude that smokers may be protected against SARS-CoV-2 infection. National and international media were interested in this story and we soon began receiving questions about this topic in general practice. In this article, we shed light on the process that resulted in the misinterpretation of observational research by scientists and the media. We also point out the methodological flaws of various studies on which hasty conclusions were based. Finally, we address the role of primary healthcare providers in mitigating the consequences of erroneous claims about a protective effect of smoking.

Changes in Smoking Behaviour and Home-Smoking Rules during the Initial COVID-19 Lockdown Period in Israel

The COVID-19 pandemic has caused devastating impacts globally. To mitigate virus spread, Israel imposed severe restrictions during March–April 2020. An online cross-sectional survey was conducted in April 2020 among current and ex-smokers to explore changes in smoking behaviour and home-smoking rules during this period. Bivariate analysis and multivariate logistic regression examined associations between sociodemographic characteristics and perceived risk of infection and quitting smoking during the initial COVID-19 period. Current smoking was reported by 437 (66.2%) of the 660 participants, 46 (7%) quit during the initial restriction period, and 177 (26.8%) were ex-smokers. Nearly half (44.4%) of current smokers intensified their smoking, and 16% attempted to quit. Quitting during the COVID-19 period was significantly associated with higher education (adjusted odds ratio (aOR): 1.97, 95% CI: 1.0–3.8), not living with a smoker (aOR: 2.18, 95% CI: 1.0–4.4), and having an underlying chronic condition that increases risk for COVID-19 complications (aOR: 2.32, 95% CI: 1.1–4.6). Both an increase in smoking behaviour and in attempts to quit smoking during the initial COVID-19 pandemic were evident in this sample of adult Israeli smokers. Governments need to use this opportunity to encourage smokers to attempt quitting and create smoke-free homes, especially during lockdown conditions, while providing mental and social support to all smokers.

Which Factors, Smoking, Drinking Alcohol, Betel Quid Chewing, or Underlying Diseases, Are More Likely to Influence the Severity of COVID-19?

The global outbreak of the coronavirus disease 2019 (COVID-19) pandemic occurred in late 2019 and early 2020. The factors that influence disease severity should be of clinical concern. Existing findings on the effects of smoking on COVID-19 are also controversial and need to be confirmed by further research. In addition, the effects of alcohol consumption and betel quid (BQ) chewing on COVID-19 are unclear. The aim of this study was to examine the demographic characteristics of COVID-19 patients and the effects of smoking, drinking, BQ chewing, and underlying diseases on the severity of COVID-19. A retrospective study was conducted on 91 patients with confirmed cases of COVID-19 hospitalized in Yueyang, Hunan Province, China from 21 January to 8 March, 2020. Patient demographic data, and information on smoking, drinking and BQ chewing, and underlying diseases were extracted from the patient electronic medical records (EMR) and telephone interviews. The chi-square test was used to conduct a univariate analysis of the factors influencing the severity of COVID-19, and ordinal logistic regression analysis was used to identify the factors related to the severity of COVID-19. The results showed that the rates of smoking, drinking and BQ chewing were 15.4, 26.4, and 7.1%, respectively, there was no significant relationship between these lifestyle factors and the severity of COVID-19 (P > 0.05). However, underlying diseases such as diabetes [odds ratio (OR) = 7.740, 95% confidence interval (CI):1.000-60.740, P = 0.050], source of infection (OR = 0.180, 95% CI: 0.030-0.980, P = 0.049), and employment status (retired/unemployed vs. employed: OR = 29.430, 95% CI, 1.050 - 822.330, P = 0.047) were significant independent predictors of severe COVID-19 infection. These individuals should be informed of methods to increase personal protection, and doctors should prevent these individuals from developing serious diseases. It is important to pay attention to the source of infection and timely medical treatment. This study showed that the clinical classification of COVID-19 was associated with patients with diabetes, source of infection, and retired/unemployed. Therefore in the clinical practice of COVID-19 should be more concern these factors. Although no statistical significance was found in smoking, drinking alcohol, BQ chewing, and severity of COVID-19 patients, more studies have confirmed that are harmful and risk factors for underlying diseases in the population. Health authorities should formulate policies to publicize the harmful effects of smoking, drinking, and betel nut chewing and promote a healthy lifestyle.

Exploring changes in cigar smoking patterns and motivations to quit cigars among black young adults in the time of COVID-19

INTRODUCTION

The COVID-19 pandemic has disproportionately impacted the Black/African American communities in the U.S. The objective of this study is to understand the change in cigar smoking patterns and motivations to quit cigars during the COVID-19 pandemic among Black young adult cigar smokers.

METHODS

During May-June 2020, in-depth telephone interviews were conducted to investigate cigar (i.e., large cigars, cigarillos, filtered cigars, and blunts) smoking behaviors during the pandemic among self-identified, non-Hispanic Black/African American young adult cigar smokers (n = 40; ages 21-29). Interviews were audio-recorded, transcribed verbatim, and coded separately by three coders. Thematic analysis was used to assess thematic patterns arising from the interviews.

RESULTS

Most participants reported smoking cigarillos and blunts in higher frequency and quantity to cope with COVID-19-induced stress, anxiety, loneliness, and boredom due to economic losses and physical isolation. Some also reported contextual changes in cigarillo and blunt smoking, including smoking around the clock, smoking immediately after waking up, and smoking an entire cigarillo or blunt in one setting. Very few participants reported motivations to quit cigars during the pandemic. Perceiving higher risks of progressed COVID-19 outcomes did not prompt participants' increased motivations for quitting cigars.

CONCLUSIONS

Black young adults in this study increasingly smoked cigarillos and blunts during the COVID-19 pandemic, mainly attributed to daily life stressors. Participants did not have increased motivations for quitting cigars to reduce COVID-19-related risks. Promoting contextually appropriate healthy coping and cigar smoking cessation may minimize COVID-19-related health consequences of cigar smoking and reduce health disparities among Black young adults.

Alcohol Consumption is Associated with Poor Prognosis in Obese Patients with COVID-19: a Mendelian Randomization Study using UK Biobank

Background

Acute and chronic alcohol abuse have adverse impacts on both the innate and adaptive immune response, which may result in reduced resistance to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and promote the progression of coronavirus disease 2019 (COVID-19). However, there are no large population-based data evaluating potential causal associations between alcohol consumption and COVID-19.

Method

We conducted a Mendelian randomization study using data from UK Biobank to explore the association between alcohol consumption and risk of SARS-CoV-2 infection and serious clinical outcomes in patients with COVID-19. A total of 12,937 participants aged 50-83 who tested for SARS-CoV-2 between 16 March to 27 July 2020 (12.1% tested positive) were included in the analysis. The exposure factor was alcohol consumption. Main outcomes were SARS-CoV-2 positivity and death in COVID-19 patients. We generated weighted and unweighted allele scores using three genetic variants (rs1229984, rs1260326, and rs13107325) and applied the allele scores as the instrumental variables to assess the effect of alcohol consumption on outcomes. Analyses were conducted separately for white participates with and without obesity.

Results

Of the 12,937 participants, 4,496 were never or infrequent drinkers and 8,441 were frequent drinkers. (including 1,156 light drinkers, 3,795 moderate drinkers, and 3,490 heavy drinkers). Both logistic regression and Mendelian randomization analyses found no evidence that alcohol consumption was associated with risk of SARS-CoV-2 infection in participants either with (OR=0.963, 95%CI 0.800-1.159; q =1.000) or without obesity (OR=0.891, 95%CI 0.755-1.053; q =.319). However, frequent drinking (HR=1.565, 95%CI 1.012-2.419; q =.079), especially heavy drinking (HR=2.071, 95%CI 1.235-3.472; q =.054), was associated with higher risk of death in patients with obesity and COVID-19, but not in patients without obesity. Notably, the risk of death in frequent drinkers with obesity increased slightly with the average amount of alcohol consumed weekly (HR=1.480, 95%CI 1.059-2.069; q =.099).

Conclusions

Our findings suggested alcohol consumption may had adverse effects on the progression of COVID-19 in white participants with obesity, but was not associate with susceptibility to SARS-CoV-2 infection.