Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data

Sarah E Jackson, Claire Garnett, Lion Shahab, Melissa Oldham, Jamie Brown, Sarah E Jackson, Claire Garnett, Lion Shahab, Melissa Oldham, Jamie Brown

Abstract

Aim: To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England.

Design/setting: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown.

Participants: A total of 20 558 adults (≥ 16 years).

Measurements: The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant).

Findings: The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (ORadj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, ORadj = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, ORadj = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, ORadj = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, ORadj = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, ORadj = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, ORadj = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, ORadj = 1.32, 95% CI = 0.64-2.75).

Conclusions: Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.

Keywords: Alcohol; COVID-19; SARS-CoV-2; alcohol reduction; drinking; quit attempts; smoking; smoking cessation.

© 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Figures

Figure 1
Figure 1
Prevalence of (a) current smoking among all adults, (b) cessation and (c) quit attempts by past‐year smokers; (d) use of evidence‐based cessation support and (e) use of remote cessation support by past‐year smokers who made a quit attempt in England, April 2019–April 2020. The dotted line indicates the timing of the COVID‐19 lockdown in England. Data for March 2020 were imputed as the average of February and April 2020 on the basis of presumed linear change
Figure 2
Figure 2
Prevalence of (a) high‐risk drinking among all adults, (b) reduction attempts by high‐risk drinkers, and (c) use of evidence‐based support; and (d) use of remote support for alcohol reduction by high‐risk drinkers who made a reduction attempt in England, April 2019–April 2020. The dotted line indicates the timing of the COVID‐19 lockdown in England. Data for March 2020 were imputed as the average of February and April 2020 on the basis of presumed linear change

References

    1. Simons D, Perski O, Brown J. COVID‐19: the role of smoking cessation during respiratory virus epidemics [internet]. The BMJ Opinion 2020 [cited 2020 May 4]. Available at: (accessed 1 September 2020).
    1. Clay J. M., Parker M. O.Alcohol use and misuse during the COVID‐19 pandemic: a potential public health crisis? Lancet Public Health 2020; 5: e259.
    1. Griswold M. G., Fullman N., Hawley C., Arian N., Zimsen S. R. M., Tymeson H. D., et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet 2018; 392: 1015–1035.
    1. Reitsma M. B., Fullman N., Ng M., Salama J. S., Abajobir A., Abate K. H., et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the global burden of disease study 2015. Lancet 2017; 389: 1885–1906.
    1. NHS Digital . Statistics on Smoking, England— ‐ 2019. [internet]. NHS Digital 2019 [cited 2019 Jul 3]. Available at:
    1. NHS Digital . Statistics on Alcohol, England 2019 [PAS] [internet]. NHS Digital. 2019. [cited 2020 May 18]. Available at:
    1. Pirie K., Peto R., Reeves G. K., Green J., Beral V.The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013; 381: 133–141.
    1. US Department of Health and Human Services . Eighth Special Report to the US Congress on Alcohol and Health. Bethesda, MD: NIH Publications; 1993.
    1. Department of Health and Social Care . Coronavirus (COVID‐19) action plan [internet]. . 2020. [cited 2020 May 14]. Available at:
    1. Lawson P. J., Flocke S. A.Teachable moments for health behavior change: a concept analysis. Patient Educ Couns 2009; 76: 25–30.
    1. Wood W., Tam L., Witt M. G.Changing circumstances, disrupting habits. J Pers Soc Psychol 2005; 88: 918–933.
    1. Fancourt D, Bu F, Mak HW, Steptoe A. COVID‐19 Social Study: Results Release 1 [internet]. 2020. [cited 2020 Apr 23]. Available at:
    1. Uhart M., Wand G. S.Stress, alcohol and drug interaction: an update of human research. Addict Biol 2009; 14: 43–64.
    1. José B. S., van Oers H. A., van de Mheen H. D., Garretsen H. F., Mackenbach J. P.Stressors and alcohol consumption. Alcohol Alcohol 2000; 35: 307–312.
    1. Fidler J. A., West R.Self‐perceived smoking motives and their correlates in a general population sample. Nicotine Tob Res 2009; 11: 1182–1188.
    1. Parrott A. C.Does cigarette smoking cause stress? Am Psychol 1999; 54: 817–820.
    1. Perski O., Jackson S. E., Garnett C., West R., Brown J.Trends in and factors associated with the adoption of digital aids for smoking cessation and alcohol reduction: a population survey in England. Drug Alcohol Depend 2019; 205: 107653.
    1. Perski O, Herbec A, Shahab L, Brown J. Has the SARS‐CoV‐2 outbreak had an impact on uptake of digital cessation support in UK smokers? An interrupted time series analysis [internet]. J Med Internet Res mHealth uHealth 2020. [cited 2020 May 22]. Available at:
    1. Public Health England . Smokers at greater risk of severe respiratory disease from COVID‐19 [internet]. 2020. [cited 2020 Apr 23]. Available at:
    1. National Health Service UK. Today is the Day [internet] [cited 2020 May 2]. Available at:
    1. Smokers seem less likely than non‐smokers to fall ill with COVID‐19. Economist [internet] [cited 2020 May 4]. Available at:
    1. Coronavirus UK. More ‘weird’ proof smokers may be at less risk. Daily Mail [internet] 2020. [cited 2020 May 4]. Available at:
    1. ASH Daily News [internet]. Action on Smoking and Health 2020. [cited 2020 May 4]. Available at:
    1. Marshallsea T, Best S. More than 300,000 Brits have quit smoking during coronavirus crisis [internet]. Mirror 2020 [cited 2020 May 4]. Available at:
    1. Alcohol Change UK. Drinking during lockdown: headline findings [internet]. Alcohol Change UK 2020. [cited 2020 May 18]. Available at:
    1. Fidler J. A., Shahab L., West O., Jarvis M. J., McEwen A., Stapleton J. A., et al. ‘The smoking toolkit study’: a national study of smoking and smoking cessation in England. BMC Public Health 2011; 11: 479.
    1. Beard E., Brown J., West R., Acton C., Brennan A., Drummond C., et al. Protocol for a national monthly survey of alcohol use in England with 6‐month follow‐up: ‘the alcohol toolkit study. BMC Public Health 2015; 15: 230.
    1. Jackson S. E., Beard E., Kujawski B., Sunyer E., Michie S., Shahab L., et al. Comparison of trends in self‐reported cigarette consumption and sales in England, 2011 to 2018. JAMA Netw Open 2019; 2: e1910161.
    1. Babor T. F., Higgins‐Biddle J. C., Saunders J. B., Monteiro M. G.AUDIT: the Alcohol Use Disorders Identification Test: Guidelines For Use in Primary Health Care. Geneva, Switzerland: World Health Organization; 2001.
    1. Bradley K. A., McDonell M. B., Bush K., Kivlahan D. R., Diehr P., Fihn S. D.The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. Alcohol Clin Exp Res 1998; 22: 1842–1849.
    1. Allen J. P., Litten R. Z., Fertig J. B., Babor T.A review of research on the alcohol use disorders identification test (AUDIT). Alcohol Clin Exp Res 1997; 21: 613–619.
    1. Saunders J. B., Aasland O. G., Amundsen A., Grant M.Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption—I. Addiction 1993; 88: 349–362.
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction 1993;88:791–804.
    1. National Institute on Alcohol and Alcoholism . Helping Patients who Drink Too Much: A Clinician’s Guide: Updated 2005 Edition. Washington, DC: US Department of Health and Human Services, National Institutes of Health; 2007.
    1. Caviness C. M., Hatgis C., Anderson B. J., Rosengard C., Kiene S. M., Friedmann P. D., et al. Three brief alcohol screens for detecting hazardous drinking in incarcerated women. J Stud Alcohol Drugs 2009; 70: 50–54.
    1. Beard E., Brown J., Kaner E., West R., Michie S.Predictors of and reasons for attempts to reduce alcohol intake: a population survey of adults in England. PLOS ONE 2017; 12: e0173458.
    1. Kotz D., West R.Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding. Tob Control 2009; 18: 43–46.
    1. Beard E., Brown J., West R., Kaner E., Meier P., Michie S.Associations between socio‐economic factors and alcohol consumption: a population survey of adults in England. PLOS ONE 2019; 14: e0209442.
    1. Heatherton T. F., Kozlowski L. T., Frecker R. C., Rickert W., Robinson J.Measuring the heaviness of smoking: using self‐reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict 1989; 84: 791–800.
    1. Aziz M. A., Kenford S.Comparability of telephone and face‐to‐face interviews in assessing patients with posttraumatic stress disorder. J Psychiatr Pract 2004; 10: 307–313.
    1. Midanik L. T., Hines A. M., Greenfield T. K., Rogers J. D.Face‐to‐face versus telephone interviews: using cognitive methods to assess alcohol survey questions. Contemp Drug Probl 1999; 26: 673–693.
    1. Farsalinos K., Barbouni A., Niaura R.Systematic review of the prevalence of current smoking among hospitalized COVID‐19 patients in China: could nicotine be a therapeutic option? Intern Emerg Med [internet] 2020. [cited 2020 May 11]; Available at:
    1. Miyara M., Tubach F., Pourcher V., Morelot‐Panzini C., Pernet J., Haroche J., et al. Low incidence of daily active tobacco smoking in patients with symptomatic COVID‐19. Qeios [internet] 2020. Apr 21; [cited 2020 Apr 23]. Available at:
    1. Simons D., Shahab L., Brown J., Perski O.The association of smoking status with SARS‐CoV‐2 infection, hospitalisation and mortality from COVID‐19: a living rapid evidence review. Qeios [internet] 2020[cited 2020 Apr 23]; Available at:
    1. Farsalinos K., Niaura R., Poulas K.COVID‐19, a disease of the nicotinic cholinergic system? Nicotine may be protective. Qeios [internet] 2020[cited 2020 Apr 27]; Available at:
    1. Changeux J.‐P., Amoura Z., Rey F., Miyara M.A nicotinic hypothesis for COVID‐19 with preventive and therapeutic implications. Qeios [internet] 2020. Apr 21; [cited 2020 Apr 24]. Available at:
    1. Enos G.Effects on lung, immune function offer warning for drinking in crisis. Alcohol Drug Abuse Wkly 2020; 32: 1–8.
    1. Koelega H. S.Alcohol and vigilance performance: a review. Psychopharmacology (Berl) 1995; 118: 233–249.
    1. Opinion: Let’s try ‘Dry COVID’—lockdown is the time to kick our national alcohol habit for good [internet]. Independent 2020. [cited 2020 May 22]. Available at:

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir