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Changes in Smoking Cessation–Related Behaviors Among US Adults During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Did smoking cessation–related behaviors change during the COVID-19 pandemic in the US?

Findings  This cross-sectional study among 788 008 US adult smokers found that the annual prevalence of past-year quit attempts decreased for the first time since 2011, from 65.2% in 2019 to 63.2% in 2020. Simultaneously, observed sales of nicotine replacement therapy brands from representative retail scanner data across 31 US states decreased by 1% to 13% compared with expected sales.

Meaning  These findings suggest a decrease in smoking cessation activity during the COVID-19 pandemic and the need to reengage smokers in evidence-based quitting strategies.


Importance  Smoking cessation is an urgent public health priority given that smoking is associated with increased risk of severe COVID-19 outcomes and other diseases. It is unknown how smoking cessation changed nationally during the COVID-19 pandemic.

Objective  To investigate changes in smoking cessation–related behaviors in the US during the COVID-19 pandemic.

Design, Setting, and Participants  This cross-sectional study was conducted using 2011 to 2020 data on 788 008 individuals who had smoked in the past year from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. Representative retail scanner sales data between January 2017 and July 2021 for 1004 unique nicotine replacement therapy (NRT) universal product codes in 31 US states from NielsenIQ were also used.

Exposures  Calendar year and 4-week sales periods.

Main Outcomes and Measures  Changes in annual self-reported prevalence of past-year quit attempts and recent successful cessation before (ie, 2011-2019) and during (ie, 2020) the COVID-19 pandemic and changes in sales volumes in millions of pieces of nicotine gum, lozenge, and patch brands before (1271 four-week sales periods between January 2017 and February 2020) and during (558 four-week sales periods between March 2020 and July 2021) the COVID-19 pandemic were calculated.

Results  The 2011 to 2020 pooled BRFSS sample (response rate range, 45.2%-49.9%) included 788 008 respondents (243 061 individuals ages 25-44 years [weighted percentage, 42.5%]; 374 519 men [weighted percentage, 55.7%]). For the first time since 2011, annual past-year quit attempt prevalence decreased between 2019 and 2020, from 65.2% (95% CI, 64.5% to 65.9%) to 63.2% (95% CI, 62.3% to 64.0%), with the largest relative decreases among individuals ages 45 to 64 years (61.4% [95% CI, 60.3% to 62.5%] vs 57.7% [95% CI, 56.3% to 59.2%]), those with 2 or more comorbidities (67.1% [95% CI, 66.0% to 68.2%] to 63.0% [95% CI, 61.6% to 64.4%]), and Black individuals (72.5% [95% CI, 70.3 to 74.6] vs 68.4% [95% CI, 65.3% to 71.3%]). Recent successful cessation remained unchanged during 2019 to 2020. Observed mean (SD) 4-week NRT sales volume in the prepandemic period was 105.6 (66.2) million gum pieces, 51.9 (31.6) million lozenges, and 2.0 (1.1) million patches. Compared with expected sales, observed sales during the COVID-19 pandemic were lower by 13.0% (95% CI, –13.7% to –12.3%) for lozenges, 6.4% (95% CI, –7.3% to –5.5%) for patches, and 1.2% (95% CI, –1.7% to –0.7%) for gum.

Conclusions and Relevance  This study found that serious smoking cessation activity among US adults decreased immediately and remained depressed for more than a year during the COVID-19 pandemic. These findings suggest that smokers experiencing disproportionately negative outcomes during the pandemic should be reengaged and assisted in quit attempts.

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Article Information

Accepted for Publication: June 16, 2022.

Published: August 1, 2022. doi:10.1001/jamanetworkopen.2022.25149

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Bandi P et al. JAMA Network Open.

Corresponding Author: Priti Bandi, PhD, Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Ste 200, Kennesaw, GA 30144 (priti.bandi@cancer.org).

Author Contributions: Drs Bandi and Asare had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bandi, Asare, Nargis, Jemal.

Acquisition, analysis, or interpretation of data: Bandi, Asare, Majmundar, Xue, Han, Westmaas, Nargis.

Drafting of the manuscript: Bandi, Nargis.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Bandi, Asare, Nargis.

Administrative, technical, or material support: Bandi, Xue, Westmaas, Nargis.

Supervision: Nargis, Jemal.

Conflict of Interest Disclosures: Dr Han reported receiving grants from AstraZeneca outside the submitted work. No other disclosures were reported.

Funding/Support: Behavioral Risk Factor Surveillance System data are publicly available at the survey’s website. NielsenIQ data was purchased by the American Cancer Society.

Role of the Funder/Sponsor: The supporters had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors would like to thank Scott Sherman, MD (New York University), for providing assistance with clinical interpretation of data and Adair K. Minihan, MPH (American Cancer Society), for providing assistance with data analysis.

Additional Information: The authors’ own analyses and calculations of nicotine replacement therapy sales were based in part on data reported by Nielsen through its Scantrack Service for the tobacco alternatives category for the 4-week period ending July 2021 for the state line market and convenience and all other retail channels (copyright 2021, Nielsen Consumer LLC NielsenIQ). NielsenIQ is not responsible for and had no role in analyzing and preparing the results reported herein.

US Department of Health and Human Services.  Smoking Cessation. A Report of the Surgeon General. Department of Health and Human Services; 2020.
Lowe  KE , Zein  J , Hatipoglu  U , Attaway  A .  Association of smoking and cumulative pack-year exposure with COVID-19 outcomes in the Cleveland Clinic COVID-19 registry.   JAMA Intern Med. 2021;181(5):709-711. doi:10.1001/jamainternmed.2020.8360PubMedGoogle ScholarCrossref
Kalkhoran  SM , Levy  DE , Rigotti  NA .  Smoking and e-cigarette use among U.S. adults during the COVID-19 pandemic.   Am J Prev Med. 2022;62(3):341-349. doi:10.1016/j.amepre.2021.08.018PubMedGoogle ScholarCrossref
Klemperer  EM , West  JC , Peasley-Miklus  C , Villanti  AC .  Change in tobacco and electronic cigarette use and motivation to quit in response to COVID-19.   Nicotine Tob Res. 2020;22(9):1662-1663. doi:10.1093/ntr/ntaa072PubMedGoogle ScholarCrossref
Yingst  JM , Krebs  NM , Bordner  CR , Hobkirk  AL , Allen  SI , Foulds  J .  Tobacco use changes and perceived health risks among current tobacco users during the COVID-19 pandemic.   Int J Environ Res Public Health. 2021;18(4):1795. doi:10.3390/ijerph18041795PubMedGoogle ScholarCrossref
Rigotti  NA , Chang  Y , Regan  S ,  et al.  Cigarette smoking and risk perceptions during the COVID-19 pandemic reported by recently hospitalized participants in a smoking cessation trial.   J Gen Intern Med. 2021;36(12):3786-3793. doi:10.1007/s11606-021-06913-3PubMedGoogle ScholarCrossref
Yang  Y , Lindblom  EN , Salloum  RG , Ward  KD .  Perceived health risks associated with the use of tobacco and nicotine products during the COVID-19 pandemic.   Tob Induc Dis. 2021;19:46. doi:10.18332/tid/136040PubMedGoogle ScholarCrossref
Gaffney  A , Himmelstein  DU , Woolhandler  S .  Smoking prevalence during the COVID-19 pandemic in the United States.   Ann Am Thorac Soc. 2022;19(6):1065-1068. doi:10.1513/AnnalsATS.202110-1184RLPubMedGoogle ScholarCrossref
US Department of Commerce. Census Bureau. National Cancer Institute and Food and Drug Administration co-sponsored tobacco use supplement to the current population survey, 2018-2019. Accessed December 10, 2021. https://cancercontrol.cancer.gov/brp/tcrb/tus-cps/
Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. Accessed December 10, 2021. https://www.cdc.gov/brfss/data_documentation/index.htm
US Census Bureau. Basic monthly CPS. Accessed December 10, 2021. https://www.census.gov/data/datasets/time-series/demo/cps/cps-basic.html
North American Quitline Consortium. Update on calls to quitlines through 1-800-QUIT-NOW! Accessed January 30, 2022. https://www.naquitline.org/news/569865/Update-on-Calls-to-Quitlines-through-1-800-QUIT-NOW.htm
Cajner  T , Crane  LD , Decker  RA ,  et al. The U.S. labor market during the beginning of the pandemic recession. National Bureau of Economic Research. Accessed June 28, 2022. https://www.nber.org/system/files/working_papers/w27159/w27159.pdf
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; the Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775PubMedGoogle ScholarCrossref
Magesh  S , John  D , Li  WT ,  et al.  Disparities in COVID-19 outcomes by race, ethnicity, and socioeconomic status: a systematic-review and meta-analysis.   JAMA Netw Open. 2021;4(11):e2134147-e2134147. doi:10.1001/jamanetworkopen.2021.34147PubMedGoogle ScholarCrossref
Czeisler  ME , Marynak  K , Clarke  KEN ,  et al.  Delay or avoidance of medical care because of COVID-19-related concerns—United States, June 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(36):1250-1257. doi:10.15585/mmwr.mm6936a4PubMedGoogle ScholarCrossref
Rigotti  NA , Kruse  GR , Livingstone-Banks  J , Hartmann-Boyce  J .  Treatment of tobacco smoking: a review.   JAMA. 2022;327(6):566-577. doi:10.1001/jama.2022.0395PubMedGoogle ScholarCrossref
Borland  R , Partos  TR , Yong  HH , Cummings  KM , Hyland  A .  How much unsuccessful quitting activity is going on among adult smokers: data from the International Tobacco Control Four Country cohort survey.   Addiction. 2012;107(3):673-682. doi:10.1111/j.1360-0443.2011.03685.xPubMedGoogle ScholarCrossref
U.S. Department of Health and Human Services. Preliminary evaluation of nonresponse bias due to the COVID-19 pandemic on National Health Interview survey estimates, April-June 2020. Accessed July 6, 2021. https://www.cdc.gov/nchs/data/nhis/earlyrelease/nonresponse202102-508.pdf
Rae  M , Amin  K , Cox  C , Panchal  N , Miller  BF . Telehealth has played an outsized role meeting mental health needs during the COVID-19 pandemic. Kaiser Family Foundation. Accessed June 3, 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/telehealth-has-played-an-outsized-role-meeting-mental-health-needs-during-the-covid-19-pandemic/
Tichy  EM , Hoffman  JM , Suda  KJ ,  et al.  National trends in prescription drug expenditures and projections for 2021.   Am J Health Syst Pharm. 2021;78(14):1294-1308. doi:10.1093/ajhp/zxab160PubMedGoogle ScholarCrossref
Asare  S , Majmundar  A , Islami  F ,  et al.  Changes in cigarette sales in the United States during the COVID-19 pandemic.   Ann Intern Med. 2022;175(1):141-143. doi:10.7326/M21-3350PubMedGoogle ScholarCrossref
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