Smoking cessation activity decreased substantially and remained low during the COVID-19 pandemic among adults in the United States. These findings were published in JAMA Network Open.
This cross-sectional study sourced data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, which was a nationally representative, telephone-based survey of adults in the US conducted annually between 2011 and 2020. Smoking cessation behaviors based on self-reported past-year quit attempts and state-level sales of nicotine replacement therapies (NRTs) were evaluated.
The pooled sample size was 788,008 individuals, 243,061 were aged 25 to 44 years and 346,915 were aged 45 to 64 years, 55.7% were men, and 68.9% were White. Between 2019 and 2020, there was a significant shift in participant demographics with more older participants and individuals living in the Northeast responding.
Findings from 2 independent data sources in this cross-sectional study suggest that serious cessation activity decreased immediately after the COVID-19 pandemic onset and remained depressed through 2021 quarter 1.
Past-year quit attempts peaked in 2014 (67.7%) and decreased from 2019 to 2020 by 2.8% to 63.2% (P =.002) and was the only single-year significant change in rate since the peak in 2014.
Stratified by demographics, the largest decrease in quit attempts since 2019 was observed among individuals aged 45 to 65 years (relative difference [RD], -6.4%; P <.001), with 2 or more comorbidities (RD, -6.1%; P <.001), Black individuals (RD, -5.7%; P =.02), with 14 or more days of activity limitation in the past 30 days (RD, -5.4%; P =.007), 14 or more days of physical distress in the past 30 days (RD, -4.9%; P =.01), and individuals surveyed in the second quarter of 2020 (RD, -4.5%; P =.009).
Prior to the COVID-19 pandemic, NRT volumes per sales period were 105.6 million gum pieces, 51.9 million lozenges, and 2.0 million patches. Compared with expected volumes, during the COVID-19 pandemic, sales of lozenges decreased by 13.0%, patches by 6.4%, and gum by 1.2%. During the 18 4-week COVID-19 sales periods, there were sales deficits in 17 of the periods for lozenges, 13 of the periods for patches, and 10 of the periods for gum.
The major limitation of this study was that the past-year recall of attempting to quit smoking could have partially accounted for the prepandemic period.
Study authors concluded, “Findings from 2 independent data sources in this cross-sectional study suggest that serious cessation activity decreased immediately after the COVID-19 pandemic onset and remained depressed through 2021 quarter 1. These results, when taken together with reports of increased cigarette sales during the pandemic, suggest the urgent need to reengage smokers in evidence-based quitting strategies, especially among individuals experiencing disproportionately negative outcomes during the pandemic.”
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.