Concerns about COVID-19 and a twitter campaign backed by United Kingdom public health agencies have helped spur more than 1 million smokers to successfully quit, according to a recent survey.1 An additional 440,000 people have tried to quit since the pandemic started, and 2.4 million have cut down on the number of cigarettes they smoke in light of the increased health risk of severe illness from coronavirus compared with nonsmokers.2 This is according to a joint study from YouGov and Action on Smoking and Health (ASH) that surveyed more than 1,000 smokers.
Since general practitioner Charlie Kenward, MB, ChB, MSc, launched a Twitter campaign #QuitforCOVID in April, Smokefree Action Coalition—an alliance of more than 300 United Kingdom organizations—along with the Association of Directors of Public Health (ADPH) and respiratory clinicians across the United Kingdom have joined in the push to encourage smokers to quit for COVID-19. This is not merely a trending hashtag; the #QuitforCOVID effort directs smokers to resources that help with their efforts to quit. At www.todayistheday.co.uk, people seeking to kick the habit can access links to support and services, and smokers can even ask questions of leading experts by tweeting @QuitforCOVID.
There are numerous factors at play influencing smokers' current attitudes toward the habit. "We are in the midst of a respiratory pandemic, which has touched all of us and forced us to think about our health and the health of those around us," said Hazel Cheeseman, director of policy for ASH. "We have also all had our lives disrupted, some of us in very profound ways, for example losing jobs or income. Clearly we know that health and financial concerns can be big drivers of quitting behavior, but also changes in daily routine can be a chance for people to break away from old habits."
Approximately 400,000 people aged 16 to 29 years have quit, compared with 240,000 people who are older than 50 years of age. According to the survey, this difference is driven by a more than two-fold higher rate of quitting among 16- to-29-year-old smokers compared to those older than 50 years of age (17% and 7%, respectively) of smokers older than age 50).
The survey shows that COVID-19 is having a significant impact on smokers' motivation to successfully quit: 2% of ex-smokers have recently stopped smoking completely due to COVID-19. The survey, the first of its kind in the United Kingdom to explore smokers' attitudes toward the habit since the pandemic began, found that approximately 25% of ex-smokers believe COVID-19 makes it less likely they will relapse, but 4% said they are more likely to relapse. A further 8% of smokers have tried to quit, 36% have cut down on the number of cigarettes they smoke daily, and 27% say they are more likely to quit because of COVID-19.
“There are so many reasons to quit smoking but never a more important time than right now during the coronavirus pandemic," Ruth Tennant, tobacco lead for the Association of Directors of Public Health, said in a news release. Emerging evidence suggests that smoking puts people more at risk from severe complications from COVID-19, and the ADPH is now supporting efforts to encourage smokers to quit for COVID."
The Smokefree Action Coalition calls on healthcare professionals to help smokers take steps to quit, citing the key role they play in connecting smokers with effective smoking cessation methods that can increase the chances of success. Those seeking resources to help support smokers in their efforts to quit can visit smokefreeaction.org.uk. ASH has partnered with Breathe 2025 and others to develop a toolkit, which is available by emailing [email protected]. The groups urge healthcare professionals to promote awareness of resources and options for smokers looking to quit by using the hashtag #QuitforCOVID on Twitter and leveraging other social media platforms.
As of this writing, the Department of Health has provided funding to extend the reach of the campaign to smokers in local authority areas with the highest rates of smoking. Paid advertising for the campaign will launch in mid-July with a respiratory doctor from Northeast England as the spokesperson.
“Smoking harms the immune system and our ability to fight off infections. Evidence is growing that smoking is associated with worse outcomes in those admitted to hospital with COVID-19," Nick Hopkinson, MD, PhD, FRCP, respiratory specialist at Imperial College London and chair of ASH, said in a news release. "Quitting smoking also rapidly reduces people’s risk of other health problems such as heart attacks and strokes—those are bad whenever they happen, so preventing them is an end in itself, but it’s especially important at a time like now when everyone is keen to stay out of hospital.”
Recent guidance from Public Health England based on available evidence states:
- Smokers generally have an increased risk of contracting respiratory infection and of more severe symptoms once infected. COVID-19 symptoms may, therefore, be more severe for smokers.
- Stopping smoking will bring immediate health benefits, including for those who have an existing smoking-related disease. This is particularly important for both smokers and the National Health System (NHS) at a time of intense pressure on the health service.3
Smoking cessation services delivered through local authority public health teams went remote when lockdown measures were put in place. The ASH survey found that most of these are being delivered via telephone, and some are supplementing this with video conferencing, text messaging, and smartphone applications.
"A lot has been learned about supporting smokers remotely, and services are finding that there are some advantages,” Ms. Cheeseman said. “I definitely expect some forms of remote support to remain part of the standard package of support for smokers even when social distancing measures are no longer needed."
With restrictions easing and people looking to get back to a "new normal," some ex-smokers, however, may have difficulty staying away from cigarettes.
"While lockdown easing may have an impact on the immediate health concerns, it will also relieve some of the stressful circumstances that people are living in, so it could be an incentive for some smokers who have felt too stressed to give quitting a go," Ms. Cheeseman said. "However, lockdown easing will likely create new temptations for some recent quitters. For example, drinking and social situations can be big risk factors for people who recently quit smoking, and with pubs opening up, that will be a real test for some. Reminding those who’ve quit what an achievement that is and helping them to maintain this for the long term should be a real priority for public health."
Smoking remains the leading cause of premature death, killing nearly 80,000 people a year in England, according to the NHS.4 For every person who dies from smoking, at least 30 people live with a serious smoking-related illness such as cancer, heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, which includes emphysema and chronic bronchitis.5 Current smokers are also 30% more likely to be admitted to the hospital.6
- 1. COVID-19 Public Monitor. YouGov. https://yougov.co.uk/topics/international/articles-reports/2020/03/17/Y…. Accessed July 9, 2020.
- 2. Simons D, Brown J, Shahab L, Perski O. The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review. https://www.qeios.com/read/UJR2AW. Updated April 23, 2020. Accessed July 9, 2020.
- 3. Public Health England. GOV.UK. Guidance COVID-19: advice for smokers and vapers. https://www.gov.uk/government/publications/covid-19-advice-for-smokers-…. Published May 29, 2020. Accessed June 1, 2020.
- 4. Statistics on Smoking, England 2019. NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/st…. Published June 2, 2019. Accessed June 1, 2020.
- 5. Smoking & Tobacco Use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/inde…. Accessed June 1.
- 6. Szatkowski L, Murray R, Hubbard R, et al. Prevalence of smoking among patients treated in NHS hospitals in England in 2010/2011: A National Audit. Thorax. 2015;70(5):498-500.