No ifs or butts about it, Covid stress has driven many back to smoking

Increased stress and anxiety during the Covid-19 pandemic may have pushed smokers to either smoke more or sway those trying quit back into smoking – raising fears of Covid-19 complications among this high-risk group should they contract the virus.

An editorial in the Lancet Respiratory Medicine journal has pointed out the evidence that suggests fewer smokers are quitting. The article raised concerns about the drop of calls to national quit-smoking lines, particularly in 2020 – the year many parts of the world were engulfed by lockdowns and growing stress levels.

The North American Quitline Consortium is one such organisations that received about 27% fewer calls to their operator portal in 2020 compared with 2019. Cigarette sales in the US also increased during 2020 for the first time in decades, with data suggesting vaping rates in adults had decreased. A national survey in the UK reported that 25% of current smokers were smoking more than usual.

“This increase in prevalence of smoking, reduction in quitting rate and potential move back to smoking from vaping, might be due in part to the increased stress and anxiety felt by many people during the pandemic,” read the editorial

While SA has experienced a drop in smoking after the temporary ban of cigarette sales last year, the National Council Against Smoking said it too had seen a drop in number of people wanting to quit smoking.

Communications manager at the council Sharon Nyatsanza said: “There was an increase in quit calls between April to June 2020, but from July 2020 to date the quit call numbers have gone back to normal. The increase can be attributable to many factors including the sales ban, Covid-19 related health consciousness, increased advertising and media exposure during this period.”

The pandemic has also been associated with mental health challenges, which are related to the mortality caused by the disease and other mitigating factors such as lockdown restrictions and social distancing. This gave rise to anxiety and depressive disorders, which in turn could have increased the prevalence of smoking.

A survey done by the US Centers for Disease Control and Prevention in June last year found elevated levels of adverse mental health conditions, substance abuse and suicidal ideation among adults in the US. The prevalence of symptoms of anxiety disorder was three times that reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was four times that reported in the second quarter of 2019 (24.3% versus 6.5%).

“Efforts to quit smoking have also been challenged by reduced access to helplines, cessation clinics, face-to-face support and appointments with GPs during the pandemic. Without the appropriate support to help them quit, people are likely to be less motivated to stop smoking. And the vicious cycle of anxiety, social isolation, lack of support and boredom is likely to fuel unsuccessful attempts to quit.

“With people spending more time at home, it is easier to relapse, with more opportunities to smoke, lack of a routine, and without observation and judgment from others,” the authors noted.

The pattern of increased smoking during the pandemic is not one that is necessarily seen globally. Some countries such as India and SA, which banned the sale of cigarettes temporarily last year, may have potentially strengthened policies to reduce the burden of tobacco use worldwide.

A report on the impact of the national cigarette sales ban during Covid-19 last year, the National Income Dynamics Study – Coronavirus Rapid Mobile, found the average daily number of cigarettes smoked decreased from 7.9 cigarettes in 2017 to 6.5 cigarettes during the sales ban and up to 8.8 cigarettes after the ban. Tobacco sales were prohibited between March 25 and August 17 2020 as part of the government’s response to the pandemic.

According to data, there were about 6.7 million adult smokers in SA before the start of the lockdown. Of these, about 536,000 or 7.9% indicated that they quit during the sales ban period, 5.7 million (84.7%) indicated they continued smoking and nearly 500,000 (7.3%) declined to answer the question. About 262,000 people who quit during lockdown indicated they started smoking again after the sales ban was lifted.

Dr Catherine Egbe, specialist scientist at the Medical Research Council’s alcohol, tobacco and other drug research unit, said the estimated 7.9% to 15.3% of smokers who quit during the lockdown “is a huge feat on its own”. She said the relapse of some smokers was expected, given the high rate of relapse after quitting.

“The report shows the public health gain we are expected to see going forward due to the number of people who have quit. An estimated 900 future premature deaths each year would be averted,” she said.

Dr Yussuf Saloojee, executive director at the National Council Against Smoking, said the decline in smoking seen during the sales ban was the “fastest decline in smoking prevalence in the country’s history”.

“Previously, a rapid decline in smoking rates was between 1994 and 2012 when strong tobacco control laws were passed in SA. About 2.4 million people stopped smoking over the 18-year period. The fall in smoking rates during the sales ban was between eight and 15 times faster than the previous period,” he said.

To reach out for help to stop smoking, contact the national quit line at 011 725 3145 or to SMS/WhatsApp 072 766 4812.