The psychosocial impact of the COVID-19 pandemic on changes in smoking behavior: Evidence from a nationwide survey in the UK.

INTRODUCTION: The stress and anxiety during this unprecedented public health crisis may lead current smokers to increase tobacco use or former smokers to relapse. Thus, this study aims to provide epidemiological evidence of the changes in smoking behavior among British smokers in response to the COVID-19 pandemic and assess the impact of psychosocial factors on these behaviors. METHODS: A nationwide survey of a representative sample of 4075 UK respondents aged >16 years was conducted between 27 April and 24 May 2020 during the COVID-19 pandemic. Psychosocial and demographic variables between different smoking behavior groups were compared using Pearson's χ2 test and Cramer's V. RESULTS: Among current smokers (n=329), one-quarter (25.2%, n=86) reported smoking more than usual, 50.9% (n=174) reported smoking the same amount, and 20.2% (n=69) reported smoking less. Significant associations were observed between different smoking behavior groups and psychosocial factors. Pearson's χ2 test revealed significant differences between different smoking behavior groups in their concerns about mental health (p<0.001), anxiety (p<0.001) and stress (p<0.001), state of low mood (p=0.012), in the Patient Health Questionnaire (PHQ) score (p=0.018) and ranking on the Cantril Ladder scale (p<0.001). Many respondents expressed that the pandemic had a more negative impact on their mental health and the impact was more pronounced among those who smoked more. CONCLUSIONS: Deterioration of mental health and psychosocial well-being were linked to increased smoking. Public health authorities should take proactive measures to provide mental healthcare and smoking cessation support as preventive measures to tackle the pandemic.