Smokers keep smoking, even as perceptions of COVID-19 risk and severity increase

As soon as the 2019 novel coronavirus was characterized as capable of causing atypical pneumonia, and subsequently named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medical and public health professionals put vulnerable populations on alert. Older adults, individuals with asthma and smokers were among the groups who have been cautioned to avoid SARS-CoV-2's accompanying illness, COVID-19, and its secondary complications (e.g., pneumonia, acute respiratory distress syndrome, septic shock).

Worldwide, more than 250 million people have contracted COVID-19, and over five million have died. In the past two years, scientific studies have confirmed that older adults are at higher risk for severe infection and death from COVID-19, particularly those with chronic conditions such as respiratory disease and smoking. They have expanded this list of high-risk comorbidities to include cardiovascular disease, diabetes, hypertension, cancer and obesity.

"Smoking is the leading cause of preventable death worldwide and increases the risk for cancer, respiratory and cardiovascular diseases, inflammation, immunosuppression, diabetes and diseases of nearly all organs in the body—many of which exacerbate COVID-19," says Jim Thrasher, professor of health promotion, education and behavior (HPEB) and international expert on tobacco control/cessation. "It is also important to note that the COVID-19 pandemic has had a negative impact on mental health, increasing stress and diagnoses of anxiety and depression."

Previous research into the relationship between COVID-19 impacts (e.g., the mental health effects of the pandemic, perceptions of risk for severe infection) and smoking behaviors have varied from country to country and population to population. These studies have revealed increases, decreases and constant rates of smoking while posing various explanations for un/changing smoking patterns (e.g., stay-at-home orders/isolation, mental health impacts).

Thrasher and his team have been conducting ongoing research on smoking in Mexico—one of the countries most affected by COVID-19. The researchers examined changes in smoking frequency, quit attempts, stress/depression, and perceived severity of COVID-19 among more than 2,750 smokers during March and July of 2020.

"Our study suggests that as the COVID-19 pandemic expanded in Mexico, depression increased, smoking frequency remained stable, and quit attempts decreased—even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe," says Emily Loud, a Ph.D. in HPEB student and lead author on the paper the team published in the International Journal of Environmental Research and Public Health. "These results suggest that Mexican adult smokers may face more difficulties with smoking cessation during COVID-19, perhaps partly due to its impact on their mental health."

The authors, including HPEB Ph.D. student Victoria Lambert, note that findings from this study can aid in the development of communication strategies to educate smokers about their risk for COVID-19.

"Mexico has large pictorial warnings on cigarette packs and changes these warnings more often than any country in the world," Lambert says. "They are the first country in the world to implement warnings about the greater severity of COVID-19 for smokers."

Further, these results should alert decision-makers to the importance of promoting access to tobacco cessation treatments. "As COVID-19 spreads and cycles in and out, interventions may need to be developed to increase smokers' perceptions of the severity of COVID-19 for themselves, not just for smokers in general, and to emphasize the COVID-related benefits of smoking cessation," Thrasher says.