United States: Smoking cessation attempts drop during COVID-19 pandemic

A recent study conducted by the American Cancer Society and published in the JAMA Network Open journal of the American Medical Association[1] shows that quit attempts declined among adult smokers in the United States early in the COVID-19 pandemic and persisted for more than a year. This reduction in quit attempts was most prevalent in populations particularly impacted by COVID-19, such as African Americans, people with comorbidities, and middle-aged people.

This study is based on data from 2011 to 2020 on nearly 800,000 smokers from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. In parallel, retail sales of more than 1,000 brands of pharmaceutical nicotine replacement products (gums, patches, lozenges, etc.) were also monitored between 2017 and 2021 in 31 states across the country.

More significant declines in certain population groups

The frequency of smokers reporting quit attempt(s) decreased in 2020 for the first time since 2011, from 65.2% in 2019 to 63.2% in 2020, with the largest declines among those aged 45 to 64 (61.4 % vs 57.7 %), those with two or more comorbidities (67.1 % vs 63 %) and African-Americans (72.5 % vs 68,4 %).

The percentage of successful saves remained statistically unchanged between 2019 (5.9%) and 2020 (6.3%). On the other hand, this percentage increased linearly between 2011 (5.3%) and 2020 (6.3%).

A decrease in sales of nicotine replacement products

Sales of nicotine replacement products in 31 states declined compared to expected sales. These declines began immediately after the onset of the COVID-19 pandemic (April 2020) and persisted through summer 2021. Overall, sales during the COVID-19 pandemic were lower than expected by $131.3T for lozenges, $6.4T for patches, and $1.2T for gum.

For the authors, these observations are consistent with the observed decrease in telephone calls to quitline helplines during this period. They can, in part, be explained by the stress linked to the pandemic and the disruptions in the health system, thus reducing access to quit treatments.

The return to “normal” sales of nicotine replacement therapy during 2021 is encouraging. The authors emphasize the urgent need to re-engage smokers in evidence-based cessation strategies, knowing that a smoker must make an average of 6 attempts to quit before succeeding.

Keywords: United States, COVID-19, pandemic, withdrawal, smoking cessation, nicotine replacement therapy

AE

[1] Bandi P, Asare S, Majmundar A, et al. Changes in Smoking Cessation–Related Behaviors Among US Adults During the COVID-19 Pandemic. JAMA Netw Open. 2022;5(8):e2225149. doi:10.1001/jamanetworkopen.2022.25149