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.