An online survey involving nearly 800 cigar smokers found while the majority of the people surveyed intended to quit smoking due to concerns about elevated health risks if they contracted COVID-19, more than twice as many reported they increased rather than decreased their tobacco use since the pandemic’s onset.

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Sarah Kowitt, PhD, MPH, is an assistant professor in the UNC School of Medicine Department of Family Medicine.

The multi-institutional study led by researchers from the University of North Carolina at Chapel Hill and UNC Lineberger Comprehensive Cancer Center examined cigar smokers’ perceived risk of COVID-19, quit intentions, and behaviors during the pandemic. Their findings were published in the International Journal of Environmental Research and Public Health.

“We are not sure why many participants reported increasing their tobacco use, but it is possible that they are stressed or anxious, they are bored at home, they stockpiled tobacco products in advance of sheltering-in-place orders, or they are not able to easily access evidence-based cessation resources like pharmacotherapy or behavioral support,” said Sarah Kowitt, PhD, MPH, the paper’s first author, and an assistant professor in the UNC School of Medicine Department of Family Medicine.

Adam Goldstein, MD, MPH, director of UNC Tobacco Intervention Programs and professor of Family Medicine at UNC School of Medicine and UNC Lineberger member, is the study’s senior author.

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Adam O. Goldstein, MD, MPH, is a UNC Lineberger member and professor in the UNC School of Medicine Department of Family Medicine.

The researchers conducted an online survey for two weeks starting on April 23 as part of an ongoing study examining perceptions of health effects of cigars. All respondents reported using cigars during the past 30 days and most used other tobacco products, like cigarettes. The average age of those surveyed was 39.3 years, most were white (66.2%), and nearly half (48.9%) were women.

Far more respondents reported increasing their tobacco use since COVID-19 started (40.9%) vs. decreasing their tobacco use (17.8%). This finding was significant, Kowitt said, “because cigar use is associated with multiple cancers and other health effects.”

However, Black or African American participants, those who used a quitline (a telephone-based tobacco cessation service), and those with higher COVID-19 risk perceptions had higher intentions to quit using tobacco due to COVID-19 and higher odds of making a quit attempt since COVID-19 started.

Nearly half (46.5%) of the respondents reported they had tried to quit smoking since the pandemic’s onset and 70.8% were planning to quit within six months. Kowitt said this finding has important public health policy implications. Studies have shown that to convert quit attempts into successful cessation, support should be made available during this time, including increased access to nicotine replacement therapy, virtual support with tobacco treatment counselors, and mental health assistance, particularly since better perceived mental health was associated with increased intentions to quit.

Kowitt said tailoring support to sub-groups of tobacco users may also be important. For instance, tobacco users who have increased their tobacco use in response to COVID-19 may need additional help with higher dependency, as well as with coping strategies targeting stress and anxiety. Those who have decreased their tobacco use have an even greater chance of successfully quitting with clinician support.

“It is important, especially during the pandemic, that we provide support for tobacco users who want to quit smoking,” said Kowitt. “A growing body of research suggests that tobacco users, compared to non-users, may be at greater risk for experiencing COVID-19 complications, so it is critical that we identify opportunities and approaches to encourage tobacco users to consider quitting and to provide them the support they need to quit successfully.”

Authors and Disclosures

In addition to Kowitt and Goldstein, the paper’s other authors are Kristen L. Jarman, MSPH, Christine E. Kistler, MD, MASc, and Leah M. Ranney, PhD, UNC School of Medicine Department of Family Medicine; Jennifer Cornacchione Ross, PhD, Wake Forest School of Medicine; Allison J. Lazard, PhD, UNC Hussman School of Media and Journalism; Paschal Sheeran, PhD, UNC Department of Psychology and Neuroscience; and James F. Thrasher, PhD, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina.

The study was funded in part by the National Cancer Institute (R01CA240732).