COVID‐19, smoking, vaping and quitting: a representative population survey in England
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Abstract
Aims
To estimate (1) associations between self‐reported COVID‐19, hand‐washing, smoking status, e‐cigarette use and nicotine replacement therapy (NRT) use and (2) the extent to which COVID‐19 has prompted smoking and vaping quit attempts and more smoking inside the home.
Design
Cross‐sectional household surveys.
Setting and participants
A representative sample of the population in England from April to May 2020. The sample included 3179 adults aged ≥ 18 years.
Measurements
Participants who reported that they definitely or thought they had coronavirus were classified as having self‐reported COVID‐19. Participants were asked how often they wash their hands after returning home, before preparing foods, before eating or before touching their face. They were also asked whether, due to COVID‐19, they had (i) attempted to quit smoking, (ii) attempted to quit vaping and (iii) changed the amount they smoke inside the home.
Findings
Odds of self‐reported COVID‐19 were significantly greater among current smokers [20.9%, adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 1.04–1.73] and long‐term (> 1‐year) ex‐smokers (16.1%, aOR = 1.33, 95% CI = 1.05–1.68) compared with never smokers (14.5%). Recent (< 1‐year) ex‐smokers had non‐significantly greater odds of self‐reported COVID‐19 (22.2%, aOR = 1.50, 95% CI = 0.85–2.53). Bayes factors indicated there was sufficient evidence to rule out large differences in self‐reported COVID‐19 by NRT use and medium differences by e‐cigarette use. With the exception of hand‐washing before face‐touching, engagement in hand‐washing behaviours was high (> 85%), regardless of nicotine use. A minority (12.2%) of quit attempts in the past 3 months were reportedly triggered by COVID‐19, and approximately one in 10 current e‐cigarette users reported attempting to quit vaping because of COVID‐19.
Conclusions
In England, current smokers and long‐term ex‐smokers appear to have higher odds of self‐reported COVID‐19 compared with never smokers in adjusted analyses, but there were no large differences between people who used nicotine replacement therapy or e‐cigarettes. Engagement in hand‐washing appears to be high, regardless of nicotine or tobacco use. A minority of past‐year smokers and current e‐cigarette users, respectively, report attempting to quit smoking/vaping due to COVID‐19.
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SciScore for 10.1101/2020.06.29.20142661: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical approval was provided by the UCL Research Ethics Committee (0498/001). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:However, there were a number of limitations. First, for some comparisons, sample sizes were small which meant there was substantial uncertainly in estimates. Second, suspected SARS-CoV-2 infection was self-reported and not confirmed with a viral or antibody test. …
SciScore for 10.1101/2020.06.29.20142661: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical approval was provided by the UCL Research Ethics Committee (0498/001). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:However, there were a number of limitations. First, for some comparisons, sample sizes were small which meant there was substantial uncertainly in estimates. Second, suspected SARS-CoV-2 infection was self-reported and not confirmed with a viral or antibody test. Given that many other infections share symptoms with COVID-19, some participants may have misdiagnosed themselves. In addition, it is likely that most participants with asymptomatic cases did not report being infected. Third, individuals with the most severe cases of COVID-19 were likely censored from our analysis, because they may have died or been hospitalised. Thus, if nicotine reduces risk of severe symptoms, fewer infected nicotine users would be censored from the analysis than non-users, leading to an upward bias in the OR between these groups. However, at its peak, only 0.02% of the UK population were in hospital with COVID-19.37 This means censoring likely had a negligible effect on the estimated proportion of participants with suspected SARS-CoV-2 infection, which ranged from 14.5% of never smokers to 22.2% of recent ex-smokers. Fourth, social desirability bias may have led participants to overreport their engagement in hand washing in order to be viewed favourably by their interviewer. Fifth, because reported engagement in hand washing was so high, there may have been a ceiling effect whereby we were unable to detect differences by smoking status, e-cigarette use or NRT use. Finally, only current e-cigarett...
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.
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