Key Takeaways

  • During the COVID-19 pandemic, some smokers have increased their use of cigarettes while others have quit.
  • Those who believed that smoking increases the risk of getting COVID-19 or having a more severe case were more likely to quit, while those who perceived more stress tended to increase their smoking.

During the pandemic, smokers might have increased their smoking due to stress and boredom. On the other hand, the fear of catching COVID might have led them to cut down or quit smoking. In fact, we found that both happened.

Nancy A. Rigotti, MD
Director, Tobacco Research and Treatment Center, Massachusetts General Hospital

BOSTON – Last year, people who smoked had a variety of responses to the COVID-19 pandemic, with some increasing their smoking to help them cope and others quitting to potentially lessen their vulnerability to COVID-19. That’s the finding of new research published in the Journal of General Internal Medicine and conducted by investigators at Massachusetts General Hospital (MGH), Vanderbilt University Medical Center and the University of Pittsburgh School of Medicine.

“Studies have shown that alcohol and opioid use increased during the pandemic, but little is known about how smokers responded,” says lead author Nancy A. Rigotti, MD, director of MGH’s Tobacco Research and Treatment Center and professor of Medicine at Harvard Medical School. “They might have increased their smoking due to stress and boredom. On the other hand, the fear of catching COVID might have led them to cut down or quit smoking. In fact, we found that both happened, and we examined reasons for both outcomes.”

Rigotti and her colleagues analyzed survey responses from 694 current and former daily smokers—the average age was 53 years, 40% were male, and 78% were white—who had been hospitalized before the COVID-19 pandemic and had previously participated in a smoking cessation clinical trial at hospitals in Boston, Nashville and Pittsburgh. The survey was administered from May to July 2020.

Sixty-eight percent of respondents believed that smoking increases the risk of contracting COVID-19 or having a more severe case. This perceived risk was higher in Massachusetts (where COVID-19 had already surged) than in Pennsylvania and Tennessee. Higher perceived COVID-19 risk was associated with a higher interest in quitting smoking.

During the pandemic, 32% of respondents increased their smoking, 37% decreased their smoking, and 31% made no change. Those who increased their smoking tended to perceive more stress.

Also, 11% of respondents who smoked in January 2020 (before the pandemic) had quit smoking by the time the survey was administered (an average of six months later), while 28% of former smokers relapsed. Higher perceived COVID-19 risk was associated with a higher likelihood of quitting and a lower likelihood of relapse.

“Even before the pandemic, tobacco smoking was the leading preventable cause of death in the United States. COVID-19 has given smokers yet another good reason to stop smoking,” says Rigotti. “Physicians, health care systems and public health agencies have an opportunity to educate smokers about their special vulnerability to COVID-19 and urge them to use this time to quit smoking for good.” 

“These messages will be more impactful if they guide smokers to programs like tobacco quitlines, which are available in every U.S. state and provide free counseling and medication to quit smoking,” adds study co-leader Hilary Tindle, MD, MPH, founding director of ViTAL, the Vanderbilt Center for Tobacco, Addiction, and Lifestyle at Vanderbilt University Medical Center. Smokers can access tobacco quitlines by calling 1-800-QUIT-NOW. Smokers can also visit to view short videos of peers who successfully quit smoking during the pandemic.

Funding for the study was provided by the National Heart Lung and Blood Institute of the National Institutes of Health.

MGH co-authors include Yuchiao Chang, PhD, Susan Regan, PhD, Jennifer H.K. Kelley, DNP, Douglas E. Levy, PhD, and Daniel E. Singer, MD. Other co-authors include Scott Lee, MD, PhD, of Vanderbilt University Medical Center, and Esa Davis, MD, of the University of Pittsburgh School of Medicine.

About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2020, Mass General was named #6 in the U.S. News & World Report list of "America’s Best Hospitals."