How Did the COVID-19 Pandemic Change Cigarette Smoking Behavior?

Background

Cigarette smoking is the leading cause of preventable death in the United States. Although smoking rates have been declining, it is unclear how the COVID-19 pandemic impacted smoking behaviors.

Methods

Following a preregistered plan, we accessed population-based data from the Behavioral Risk Factor Surveillance System (2010–2023) to analyze three primary outcomes: (1) currently smoking, (2) number of cigarettes per day, and (3) quit smoking in the past year. Two-way fixed effect linear regression models accounted for state-level factors and temporal trends. Splitting each survey into an early and late wave, we identified the effect of exposure to the COVID-19 pandemic by comparing changes in an unexposed reference group (interviewed January 1–March 20, early wave) with the changes in an exposed group (interviewed January 1–March 31, late wave).

Results

The sample included 1,449,112 responses, among which 12.8% were in the late wave. Baseline smoking prevalence was 15.9% in the late wave, with an average of 12.5 cigarettes smoked per day among smokers. 8.6% of the late-wave respondents attempted to quit smoking in the past year. Overall, we found a negative 1.7% point association between the pandemic and smoking prevalence. However, among smokers, we found that the pandemic was associated with 5.1 more cigarettes smoked per day. The pandemic was also associated with a 6.3% point decline in the probability of attempting to quit smoking in the past year. While these results did not vary significantly over time, we did observe heterogeneous associations between the pandemic and smoking outcomes by socioeconomic subgroups.

Conclusions

Smoking prevalence continues to decline in the United States, and the pandemic appeared to have been associated with lower smoking rates. However, our results suggest that the pandemic was also associated with greater intensity and fewer quit attempts among smokers warranting greater attention from policymakers and researchers.