Collateral Damage: COVID-19 Stalls Progress on Smoking Cessation

A hidden but potentially disastrous consequence of the COVID-19 epidemic is its effect on smoking. Although the 2020 data on smoking prevalence have yet to be released, there is disturbing evidence that the impressive recent declines in adult and youth smoking may have stalled or even reversed. Hints that this has happened come from reports from state quitlines, where volume has plummeted by 27% (NAQC report), the lowest level since 2007, and from tobacco company reports of flat or even modest increases of sales of tobacco products, which had previously been in steady decline. 

At the beginning of the outbreak, I speculated on factors that might favor smoking cessation as well as those that might inhibit it. Theoretical factors in favor of cessation included fewer opportunities to be in outdoor spaces, where smoking is better tolerated; sheltered living circumstances whereby family and friends are more exposed to second-hand smoke; and loss of income that made purchasing tobacco products less attractive. In addition, evidence emerged that people who smoked and became infected with COVID had more severe clinical outcomes, thereby creating another incentive to quit in addition to the many other well-known health consequences of smoking. On the other hand, it could be that the heightened anxiety and depression caused by the epidemic and its resultant restrictions would make it harder to quit. While it is likely that both factors were at play, it now seems likely that, on balance, COVID has hampered smoking cessation. Plus, concern about lung injury caused by vaping street cannabis products containing Vitamin E oil acetate might have induced some smokers who had switched to vaping to resume smoking.

What can be done to regain the earlier momentum? One obvious strategy is to overcome the epidemic by combining preventive health measures such as masking and social distancing with widespread vaccine distribution. But there is also a case for greater focus on smoking cessation. For example, the CDC just celebrated 10 years of its successful TIPs From Former Smokers media campaign and is about to go back into the field with a new wave of advertisements. The Smoking Cessation Leadership Center is pleased to partner with the CDC to help disseminate these messages via social media. In addition, SCLC is embarking on a separate campaign, supported by The Robert Wood Johnson Foundation, that focuses on the many people with behavioral health problems who smoke.

The SCLC campaign features four individuals and their true stories of how COVID motivated them to quit smoking—and how much better they feel both physically and mentally because they stopped These stills and videos will be seen on Facebook, Twitter and Instagram, as well as on our website where they will be available to download. SCLC will host a webinar on March 31 during which the founder and creative director of Better World Advertising and the president of Burness, a consulting group based in Washington D.C., will explain what went into creating the campaign and also how to use it for greatest impact.

In the midst of all the focus on the tragic COVID-19 epidemic, it is not surprising that long-standing problems such as smoking, get relegated to the side. But we should not forget that about 500,000 Americans die prematurely each year from smoking-related illnesses, which is comparable to the death toll from the COVID-19 epidemic. Let’s take advantage of the current crisis to renew our efforts to reduce the devastating harm from tobacco. The past year also saw a renewed focus on social justice and equity. Smoking is disproportionately concentrated among the most vulnerable segments of our population, many of whom are also at increased risk of COVID-19 infection and illness. Sound public health principles call for a war not only on the acute epidemic, but also on the chronic one.