This Saturday, March 2nd, 2013, a cigarette is burning in an ashtray in Hayneville, Ala. Anti-smoking advocates warn that the stress and disruption of the COVID-19 pandemic may have slowed efforts to get more Americans to quit in 2020. (AP Photo / Dave Martin)

A year after COVID-19 changed the lives of millions of Americans, there are worrying signs that the coronavirus may also have slowed progress against another deadly health threat: smoking.

In the past year, fewer smokers have called the smoking cessation lines and some have smoked more, which has contributed to an unusual surge in cigarette sales – all amid the stress, fear and uncertainty caused by the pandemic.

“It’s hard for people to quit tobacco at the best of times. So what happens when life is suddenly turned upside down?” said Jen Cash, who oversees Minnesota’s tobacco control programs.

Researchers are already concerned about the impact of COVID-19 on cancer screenings and opioid overdoses as many Americans have been cut off from routine treatments and exams. But services that help smokers quit – by phone and online – seem well-positioned to weather the disruption of the pandemic. The programs help develop a plan and often offer free nicotine gums and patches.

Calls to states routed through a national helpline fell 27% last year to about 500,000 – the largest decrease in a decade, according to the North American Quitline Consortium. In a recent report, the coalition of anti-smoking advisors referred to the pandemic and the decline in public awareness.

“It’s really disturbing to see the drop in calls when the line was dropped because they are exactly what I was hoping for,” said Dr. Nancy Rigotti of Harvard Medical School, who was not part of the report.

In a separate survey of 1,000 adult smokers, Rigotti and her colleagues found that about a third smoked more in the first six months of the pandemic.

Los Angeles-based Alli Comstock had been smoke-free for seven years when she lost her childcare job due to the pandemic last March. Faced with her first long-term unemployment, she started smoking again out of boredom and fear.

“It just felt like something different and I felt calmer,” said Comstock, 32, adding that she knows that cigarettes containing the stimulant nicotine won’t help relieve anxiety.

Comstock eventually gave up after months of feeling like “we were in a time when it didn’t matter”.

“I realized in November that it was important and that I was a smoker and I didn’t mean to be,” she said.

Research has linked other traumatic events to relapses in ex-smokers, including after the 9/11 attacks.

The Centers for Disease Control and Prevention say it is too early to gauge the impact of the pandemic on smoking rates. In a statement, the CDC noted that while cigarette sales rose by the first locks last March, they have since fallen to earlier levels. This suggests that the increase was mainly due to smokers who stocked up on cigarettes.

The US smoking rate has remained constant at around 14% in recent years after a decade-long decline of over 40% in the 1960s. Smoking, which can cause cancer, strokes, and heart attacks, is blamed for around 480,000 deaths each year.

Because smoking overlaps many other forms of addiction, data on abandonment attempts are closely monitored by doctors treating people who abuse drugs and alcohol, many of whom also suffer from depression and anxiety.

Dr. Brian Hurley of the Los Angeles County’s Health Department says addicts are less likely to recover if they keep smoking. The decline in hotline calls over the past year indicates “a vortex of poorer results,” said Hurley, a board member of the American Society of Addiction Medicine.

However, according to CDC figures, quitting is notoriously difficult as only 7% are successful. Many smokers are referred to smoking cessation hotlines during their annual survey. These dates were largely canceled last spring, along with most of the other non-essential measures.

However, last year’s data on smoking cessation calls also contains positive news. Smokers who called the Minnesota hotline said they smoke more but also said they were more motivated to quit because of COVID-19. These mirrored national data show that smokers are aware that smoking can make them more susceptible to serious illness due to coronavirus infection.

Experts who want to explain last year’s trends also point to a decline in anti-smoking advertising campaigns by health authorities. In many cases, these promotions have been replaced with messages about masking, social distancing, and hand washing.

The CDC recently resumed its national “Tips From Smokers” advertising campaign and conducts its annual adult and teen tobacco use surveys, the definitive snapshot of smoking and vaping in the US.

Prior to the virus outbreak, the main focus was on the alarming increase in electronic cigarette use among high school and middle school students. Survey data, conducted before classrooms closed, showed teen vaping was already declining compared to 2019 after new taste bans were passed and the legal age for purchase was raised.

With teenagers unable to attend school or be in regular contact with their friends, researchers speculate that the pandemic may have slowed the social spread of vaping further.

“I feel it had a positive effect on vaping in teenagers, but negative on smoking in adults,” Rigotti said.

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