Change in Patterns of Tobacco Use during Lockdown due to COVID-19

Introduction: Tobacco consumption is among the biggest public health concerns globally, causing disease, disability, premature deaths with additional economic, social and environmental burden. The COVID-19 pandemic led to a nationwide lockdown in India which affected tobacco consumption due to various reasons. Objectives: This community-based-cross-sectional study aimed to assess the change in patterns of tobacco use during and after the lockdown. It also attempted to assess access to tobacco, withdrawal symptoms experienced, and perceptions about association of tobacco use with COVID-19. Methods: The study was conducted in Aliganj, an urbanized village, in South Delhi. 140 adults(aged >15 years) who used tobacco before the lockdown, residing in Aliganj were included in the study. Data was analysed using SPSS-21. Results: The prevalence of change in pattern of tobacco use during lockdown was 71.4% (66.7% smokers, 77.4% smokeless tobacco(SLT) users, 73.3% dual users). Quitting tobacco reported by 27.8% smokers, 30.2% SLT users, 13.3% dual users. A change in pattern after lockdown reported by 49.3% (45.8% smokers, 45.3% SLT users, 80% dual users). 46.2% reported experiencing withdrawal symptoms. Difficult availability of tobacco during lockdown reported by 60.0% and unavailability by 15.2%. Increased risk of COVID-19 infection among smokers and higher risk of developing severe disease perceived by 51.4% and 64.3%, respectively. Conclusion: Clear impact of lockdown on tobacco use is indicated by the difference between change in tobacco use pattern during and after lockdown. Lockdown restrictions led to decreased income, increased prices and decreased availability of tobacco, which were major reasons for changed pattern during lockdown. Lifting of restrictions (post lockdown period) resulting in return to regular pricing, availability of tobacco products and lack of support for those who experienced withdrawal symptoms, caused return to old patterns of usage after lockdown. The factors identified in this study, if translated to policy change, might be effective in reducing tobacco usage during the pandemic and beyond.. low-income families with the diversion of family income used to meetessential household expenses. The COVID-19 pandemic led to a nationwide lockdown from 25th March’20 in India. The gradual relaxation of lockdown began from 1st June’20 with continued restrictions in containment zones (areas with high prevalence of COVID-19). During the lockdown, people also experienced financial hardships due to decreased income.Shops selling and providing nonessential goods or services including tobacco products were closed. Contaminated hands and cigarettes/bidis may increase the risk of contracting COVID-19 while smoking. Hukkah is commonly used in communal settings, increasing the chances of contracting COVID-19through sharing of mouth-piece among users. During the lockdown, most of the population remained indoors, which could have increased the exposure of second-hand smoke among family members of smokers. Chewing of tobacco also leads to spitting. Spitting in public places by a SARS-CoV-2 infected person can increase the risk of spreading the virus in the community. Several studies have been conducted about the effect of smoking on covid-19. They have established an association between tobacco use and increased risk of contracting covid-19 and a severe form of the disease with poor outcomes such as the need for ICU care, mechanical ventilation, or mortality [3,6,7,8,9]. Few studies have been conducted on the change in patterns of tobacco use during lockdown [4,5]. This study was planned to assess the alteration in patterns of tobacco use during lockdown due to COVID-19 amongst adults residing in a community in New Delhi and to study the factors associated with alteration in that patterns of tobacco use.