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Gravely S, Craig LV, Cummings KM, Ouimet J, Loewen R, Martin N, Chung-Hall J, Driezen P, Hitchman SC, McNeill A, Hyland A, Quah ACK, O’Connor RJ, Borland R, Thompson ME, Boudreau C, Fong GT. Smokers' cognitive and behavioural reactions during the early phase of the COVID-19 pandemic: Findings from the 2020 ITC Four Country Smoking and Vaping Survey. PLoS One 2021; 16:e0252427. [PMID: 34086706 PMCID: PMC8177641 DOI: 10.1371/journal.pone.0252427] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/15/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION COVID-19 is primarily a respiratory illness, and smoking adversely impacts the respiratory and immune systems; this confluence may therefore incentivize smokers to quit. The present study, conducted in four high-income countries during the first global wave of COVID-19, examined the association between COVID-19 and: (1) thoughts about quitting smoking; (2) changes in smoking (quit attempt, reduced or increased smoking, or no change); and (3) factors related to a positive change (making a quit attempt or reducing smoking) based on an adapted framework of the Health Belief Model. METHODS This cross-sectional study included 6870 adult smokers participating in the Wave 3 (2020) ITC Four Country Smoking and Vaping Survey conducted in Australia, Canada, England, and United States (US). These four countries had varying responses to the pandemic by governments and public health, ranging from advising voluntary social distancing to implementing national and subnational staged lockdowns. Considering these varying responses, and the differences in the number of confirmed cases and deaths (greatest in England and the US and lowest in Australia), smoking behaviours related to COVID-19 may have differed between countries. Other factors that may be related to changes in smoking because of COVID-19 were also explored (e.g., sociodemographics, nicotine dependence, perceptions about personal and general risks of smoking on COVID-19). Regression analyses were conducted on weighted data. RESULTS Overall, 46.7% of smokers reported thinking about quitting because of COVID-19, which differed by country (p<0.001): England highest (50.9%) and Australia lowest (37.6%). Thinking about quitting smoking because of COVID-19 was more frequent among: females, ethnic minorities, those with financial stress, current vapers, less dependent smokers (non-daily and fewer cigarettes smoked/day), those with greater concern about personal susceptibility of infection, and those who believe COVID-19 is more severe for smokers. Smoking behaviour changes due to COVID-19 were: 1.1% attempted to quit, 14.2% reduced smoking, and 14.6% increased smoking (70.2% reported no change). Positive behaviour change (tried to quit/reduced smoking) was reported by 15.5% of smokers, which differed by country (p = 0.02), where Australia had significantly lower rates than the other three countries. A positive behavioural smoking change was more likely among smokers with: lower dependence, greater concern about personal susceptibility to infection, and believing that COVID-19 is more severe for smokers. CONCLUSIONS Though nearly half of smokers reported thinking about quitting because of COVID-19, the vast majority did not change their smoking behaviour. Smokers were more likely to try and quit or reduce their smoking if they had greater concern about susceptibility and severity of COVID-19 related to smoking. Smokers in Australia were least likely to reduce or try to quit smoking, which could be related to the significantly lower impact of COVID-19 during the early phase of the pandemic relative to the other countries.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | | | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Sara C. Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
- Shaping Public hEalth poliCies To Reduce ineqUalities and harM (SPECTRUM), Nottingham, United Kingdom
| | - Andrew Hyland
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Richard J. O’Connor
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Ron Borland
- School of Psychological Sciences, Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Australia
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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Gravely S, Meng G, Cummings KM, Hyland A, Borland R, Hammond D, O’Connor RJ, Goniewicz ML, Kasza KA, McNeill A, Thompson ME, Hitchman SC, Levy DT, Thrasher JF, Quah AC, Martin N, Ouimet J, Boudreau C, Fong GT. Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys. Int J Environ Res Public Health 2020; 17:ijerph17197084. [PMID: 32992667 PMCID: PMC7579485 DOI: 10.3390/ijerph17197084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022]
Abstract
This descriptive study of smokers (smoked at least monthly) and recent ex-smokers (quit for ≤2 years) examined transitions over an 18 month period in their smoking and vaping behaviors. Data are from Waves 1 (W1: 2016) and 2 (W2: 2018) of the ITC Four Country Smoking and Vaping Survey, a cohort study of adult (≥18+) smokers, concurrent users (smoke and vape), and recent ex-smokers from Australia, Canada, England, and the United States (US). Respondents (N = 5016) were classified according to their smoking and vaping status, which resulted in eight subgroups: (1) exclusive daily smokers (2) exclusive non-daily smokers; (3–6) concurrent users (subdivided into four groups by each combination of daily/non-daily smoking and daily/non-daily vaping); (7) ex-smokers who vape; (8) ex-smokers not vaping. The analyses focused first on describing changes between groups from W1 to W2. Second, transition outcomes were assessed based on changes in smoking and vaping between W1 and W2. Transitions focused on smoking were: no change in smoking (continued smoking at the same frequency); decreased smoking; increased smoking; discontinued smoking; relapsed (ex-smokers at W1 who were smoking at W2). Transitions focused on vaping were: initiated vaping; switched from smoking to vaping. Overall, this study found that the vast majority of smokers were smoking 18 months later. Non-daily smokers were more likely than daily smokers to have discontinued smoking (p < 0.0001) and to have switched to exclusive vaping (p = 0.034). Exclusive non-daily smokers were more likely than exclusive daily smokers to have initiated vaping (p = 0.04). Among all W1 daily smokers, there were no differences in discontinued smoking between daily smokers who vaped (concurrent users) and exclusive daily smokers; however, concurrent users were more likely than exclusive daily smokers to have decreased to non-daily smoking (p < 0.001) or to have switched to vaping by W2 (p < 0.001). Among all W1 non-daily smokers, there were no significant differences in increased smoking or discontinued smoking between concurrent users or exclusive smokers. Most ex-smokers remained abstinent from smoking, and there was no difference in relapse back to smoking between those who vaped and those who did not.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (S.G.); (G.M.); (A.C.K.Q.); (N.M.); (J.O.)
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (S.G.); (G.M.); (A.C.K.Q.); (N.M.); (J.O.)
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (A.H.); (M.L.G.); (K.A.K.)
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (A.H.); (M.L.G.); (K.A.K.)
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (A.H.); (M.L.G.); (K.A.K.)
| | - Karin A. Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (A.H.); (M.L.G.); (K.A.K.)
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (A.M.); (S.C.H.)
- Shaping public health policies to reduce inequalities & harm (SPECTRUM), The University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, ON N2L 3G1, Canada; (M.E.T.); (C.B.)
| | - Sara C. Hitchman
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (A.M.); (S.C.H.)
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA;
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (S.G.); (G.M.); (A.C.K.Q.); (N.M.); (J.O.)
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (S.G.); (G.M.); (A.C.K.Q.); (N.M.); (J.O.)
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (S.G.); (G.M.); (A.C.K.Q.); (N.M.); (J.O.)
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, ON N2L 3G1, Canada; (M.E.T.); (C.B.)
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (S.G.); (G.M.); (A.C.K.Q.); (N.M.); (J.O.)
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
- Correspondence:
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