Smoking trajectories over the first year of the pandemic in UK middle-aged adults: evidence from the UKHLS COVID-19 study

  1. Thierry Gagné

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Abstract

Background

The COVID-19 pandemic has altered the conditions leading people to smoke. Multiple studies have examined changes in population levels of smoking at the start of the pandemic. However, conclusions remain mixed due to the high proportion of studies with poor methods and short follow-up periods.

Methods

This study used longitudinal data from the UKHLS COVID-19 study to derive smoking trajectories among 4,130 UK adults aged 35-64 across four time points over the first year of the pandemic (2018-19, April 2020, September 2020, and January 2021). Random-effects models were used to examine subject-specific changes across time points.

Results

Between the pre-pandemic estimate and January 2021, there was a significant decline in smoking from 14.8% to 13.1% (PR = 0.89, 95%CI 0.83-0.95). The number of cigarettes smoked per day among smokers increased in April 2020 ( B = 0.5, 95%CI 0.0, 1.0) and September 2020 ( B = 1.0, 95%CI 0.4, 1.5), but declined back to pre-pandemic levels in January 2021 ( B = 0.3, 95%CI -0.3, 0.8). These changes did not vary by sex, ethnicity, relationship status, education, occupation, or household income.

Conclusion

Among UK adults aged 35-64, there has been a slight decrease in smoking which was maintained up to January 2021. Whereas there was an increase in cigarette consumption among smokers at the start of the pandemic, this was no longer observable in January 2021. The findings support the argument that the first year of the pandemic is unlikely to have had a negative effect of most middle-aged adult smokers’ trajectory.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.11.22274937: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableThe following variables in Wave 10 (2018-19) were considered to explore differences in changes over time: 1) sex (male / female), 2) living with a partner (yes / no), 3) having a White UK ethnicity (yes / no), 4) having a university degree (yes / no), 5) their current occupation level based on the 3-category National Statistics Socioeconomic Classification (professional or managerial / intermediate / routine or manual / not currently employed), and 6) their net household monthly income (quintile-based).
    RandomizationI then test population-average estimates (i.e., pooled Poisson and linear models with clustered standard errors) and subject-specific estimates (i.e., random-intercept Poisson and linear models) to assess changes over time in: 1) smoking prevalence among the full sample of observations (Table 2), and 2) cigarettes smoked per day among the subsample of observations that smoked (Table 3).6 Finally, I tested interactions and their statistical significance to see if changes varied across groups.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study is not without limitations. Only 26% of those aged 35-64 with a full interview in 2018-19 were included in our analytic sample, meaning that our analyses are unlikely to be representative despite the use of the survey weights provided by the UKHLS team. The focus on middle-aged adults precludes generalisations to other age groups, particularly younger adults who are still in the process of initiating smoking9,10 and have faced the brunt of the economic consequences of the pandemic.11 Results from the English Smoking Toolkit Study, which recorded a potential increase in smoking prevalence among those aged 16-24 between 2019 and 2021, support the call for better evidence in young adults.12 The findings here may also not align with the reality of other countries in keeping with the intensity of the impact of the pandemic and the government’s response.13 Despite these concerns, the findings represent encouraging results. Since disasters and recessions affect individuals over a long period of time, studies will be needed to understand the long-term effects of the pandemic on smoking trajectories over the next decade.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.05.11.22274937v1 on medRxiv