In their recent piece, Klemperer et al.
1
explore how motivations to quit combustible and electronic cigarettes (e-cigs) changed
in response to concerns about increased risk of infection by the novel coronavirus.
We offer complimentary findings from our online survey, which was conducted during
a similar time period (April 4–14, 2020).
We surveyed 6800 combustible and e-cig users under a variety of lockdown measures
across five countries: Italy, India, South Africa, the United Kingdom, and the United
States.
2
In the United States, we restricted our target population to California and New York
given the trajectory of the virus’ spread in these states. We aimed to find out whether
the lockdown affected the physical and emotional well-being of nicotine users, whether
usage behaviors changed, and whether altered usage patterns affected others. At the
time of the survey, Italy, India, and South Africa had restricted outdoor exercise;
but in all countries surveyed, essential outdoor activities like going to a grocery
store or pharmacy were permitted. South Africa was the only country to ban the sales
of alcohol, tobacco, and vaping products.
The Klemperer et al. sample mainly consists of dual users who do not typically use
tobacco or e-cigs every day. In our sample, the largest group in all countries was
comprised of individuals who exclusively smoke combustible cigarettes. We surveyed
many dual- and poly-product users, but only a small group of exclusive vapers. This
distribution likely represents an urban population, especially in South Africa and
India. Several methodological reviews have shown that nonrandomized online samples
may not reflect the general population.
3
We observed that e-cig consumption has marginally increased during lockdown; however,
the types of products used and the frequency of that use remain virtually unchanged.
In India, a large part of the surveyed population believe that smoking and vaping
increase the risk of contracting COVID-19. In Italy, more than half believe that there
is no relation between COVID-19 risk and smoking or vaping. Results from the other
countries were less stark, although vaping was usually considered less of a risk than
smoking combustible cigarettes. In a large proportion of users, the desire to quit
smoking or vaping for health reasons has been affected by direct experience of the
COVID-19 outbreak. In the United Kingdom and the United States, this proportion was
twice as high among participants living lived in a household where someone had tested
positive for the virus. Participants from such households in all countries also expressed
that the lockdown had a more negative impact on their mental health.
We found that slightly more users in our study had attempted to quit all nicotine
and tobacco products than in the Klemperer et al. study. This may be because their
study asked specifically about quit attempts in order to reduce harm from COVID-19,
whereas we asked about general quit attempts during the lockdown. Therefore, we might
have also captured attempts that were made for other reasons, such as restricted product
access or increased difficulties in product consumption during lockdown.
Despite differences in lockdown regulations, many of our results are consistent across
countries. Most nicotine consumers report using nicotine products as their main stress
and anxiety coping mechanism. Survey respondents were concerned about becoming ill
with the virus, losing their jobs, and dealing with stress. Despite constant consumption
trends, many exclusive combustible cigarette smokers have been buying more cigarettes
than usual, triggered by fear that stores might run out of stock or be closed during
lockdown. These findings are in line with market reports of stockpiling behavior.
4
Smoking in the home increased in Italy and India among exclusive combustible cigarette
smokers, which could increase secondhand smoke exposure for nonsmoking family members.
Among exclusive e-cig users, no change was observed in rates of in-home vaping during
the lockdown compared with pre-COVID-19 habits.
Our study complements and confirms the Klemperer et al. study in many respects. Follow-up
studies must occur after lockdown measures are lifted to evaluate the long-term consequences
that lockdown measures will have on smoking and vaping behavior.
Supplementary Material
A Contributorship Form detailing each author’s specific involvement with this content,
as well as any supplementary data, are available online at https://academic.oup.com/ntr.
ntaa097_suppl_supplementary_Taxonomy_form
Click here for additional data file.
Funding
This survey was funded by the Foundation for a Smoke-Free World.
Declaration of Interests
None declared.