Moderators of changes in smoking, drinking, and quitting behaviour associated with the first Covid-19 lockdown in England

Abstract

Aim

To estimate changes in smoking, drinking, and quitting behaviour from before to during the first Covid-19 lockdown in England, and whether changes differed by age, sex, or social grade.

Design

Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020.

Setting

England.

Participants

36,980 adults (≥18y).

Measurements

Independent variables were survey month (pre-lockdown: August-February vs. lockdown months: April-July) and year (pandemic: 2019/20 vs. comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success, and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts, and use of evidence-based or remote support. Moderators were age, sex, and occupational social grade (ABC1=more advantaged/C2DE=less advantaged).

Findings

Relative to changes over the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence (+24.7% in 2019/20 vs. 0.0% in 2018/19, OR _adj=1.35[95%CI=1.12-1.63]) and quit attempts (+39.9% vs. −22.2%, OR _adj=2.48[1.76-3.50]) among 18-34 year-olds, but not older groups. Increases in cessation (+156.4% vs. −12.5%, OR _adj=3.08[1.86-5.09]) and the success rate of quit attempts (+99.2% vs. +0.8%, OR _adj=2.29[1.31-3.98]) were also observed, and did not differ significantly by age, sex, or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence across all sociodemographic groups (+39.5% vs. −7.8%, OR _adj=1.80[1.64-1.98]), with particularly high increases among women (OR _adj=2.17[1.87-2.53]) and social grades C2DE (OR _adj=2.34[2.00-2.74]). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (OR _adj=2.31[1.78-3.00]) but not C2DE (OR _adj=1.25[0.83-1.88]), with larger increases among those aged 18-34 (OR _adj=2.56[1.72-3.81]) and ≥60 (OR _adj=1.43[1.05-1.95]) than 35-59 (OR _adj=2.51[1.51-4.18]). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small.

Conclusions

In England, the first Covid-19 lockdown was associated with increased smoking prevalence among younger adults, and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socioeconomic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE) but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).