COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran

A cross-sectional survey of medical and other groups' awareness, perceptions, and willingness to use e-cigarettes during the COVID-19 pandemic

Background

In China, people's perceptions towards electronic cigarettes during Corona Virus Disease 2019 (COVID-19) pandemic compared with pre-pandemic conditions have not been explored. Exploring the perceptions of medical workers regarding e-cigarettes is crucial, as they serve as a trusted source of information and providers of smoking cessation counselling for smokers. This cross-sectional study was designed to explore the awareness and perceptions of e-cigarettes among Chinese medical and other groups in the context of the COVID-19 pandemic.

Methods

A cross-sectional survey was performed using an online, anonymous, and self-administered questionnaire. The questionnaire contained sections for collecting participants' general information and Likert scale questions regarding smoking status, perceptions of e-smoking, attitude, and willingness to use e-cigarettes. The respondents included medical students, clinical doctors, and other occupations. Data analysis was performed using tools such as descriptive analysis, binary logistic regression, and multivariate regression.

Results

A total of 952 people completed the questionnaire, and 96.54% of them reported to have heard about e-cigarettes. The most common source of information about e-cigarettes was advertising. Notably, 28 of the 116 smokers reported that they had used e-cigarettes. Independent-samples T-tests results showed that medical groups believed e-cigarettes contained tar (p = 0.03). Most of the medical and non-medical participants maintained neutral attitudes towards e-cigarette policies (38.3%) and prices (49.2%) but their views were significantly different (p < 0.001). Multivariate logistic regression indicated that highly educated people had higher knowledge about e-cigarettes relative to those with lower education (undergraduate, OR = 1.848, 95CI% = 1.305-2.616, p = 0.001; master's degree or doctoral degree, OR = 1.920, 95CI% = 1.230-2.997, p = 0.004). The medical group used fewer e-cigarettes compared to non-medical group (OR = 1.866, 95CI% = 1.185-2.938, p = 0.007), the non-traditional cigarette users showed lower utilization compared to traditional cigarette users (18-40, OR = 4.797, 95CI% = 0.930-24.744, p = 0.061; > 40, OR = 9.794, 95CI% = 1.683-56.989, p = 0.011) and the older adult used fewer than the young (18-40, OR = 4.797, 95CI% = 0.930-24.744, p = 0.061; > 40, OR = 9.794, 95CI% = 1.683-56.989, p = 0.011).

Conclusion

This study found that individuals tend to hold negative attitudes towards the awareness, perceptions, and willingness to use e-cigarettes. Medical groups are less likely to use e-cigarettes, but misperceptions are still prevalent among them. This calls for additional training for such medical personnel to improve their capacity to provide necessary counselling to smokers. E-cigarettes advertisements were the main source of information for young individuals to learn about e-cigarettes, and hence measures should be taken to restrict exposure of young individuals to e-cigarettes.

Impact of Covid-19 on Caller Characteristics and Quit Rates: Experience of Regional Tobacco Quitline From India

BACKGROUND

The tobacco epidemic is a major health concern amplified by Covid-19. We aimed to study differences in caller profiles to the regional tobacco quitline services of South India during the Covid-19 pandemic in comparison with the prepandemic.

METHOD

Using a descriptive cross-sectional research design, we examined registered caller profiles to the quitline between March and July 2019 (Prepandemic N = 7845) and the same months in 2020 (Covid-19 pandemic phase N = 6447) phases.

RESULTS

The proportion of registered callers with an expressed intent to quit tobacco increased by 1.73 times during pandemic (16.7% versus 9.6%). Health concerns were cited as the major reason (93.25%) to quit tobacco in 2020 as compared to 2019 (88.02%). Cough (28.50%) and psychological difficulties (14.20%) were reported significantly more by RCs in 2020. Self-reported quit rates were significantly higher among RCs in 2020 as compared to 2019 on the quit day (2019-47.37% & 2020-77.54%, p = .001), at one week (2019-25.17% and 2020-56.06%, p = .001) as was one-month continuous abstinence (2019-11.88% and 2020-39.60%, p = .001).

CONCLUSION

The pandemic resulted in a greater intent to quit among registered callers to the quitline. However, awareness about the quitline services as well as other tobacco cessation services needs to be expanded to reach more tobacco users.

IMPLICATIONS

Pandemics offer an opportunity to change health risk behaviors. During the Covid-19 pandemic, callers to the tobacco quitline were more motivated to quit tobacco and attributed it to concerns about the health risks from tobacco use, particularly during the pandemic. Quit rates also increased significantly during the pandemic as compared to before. These gains in encouraging tobacco cessation need to be maintained beyond the pandemic by strengthening existing quitlines and other supports for tobacco cessation.

SARS-CoV-2 in municipal wastewater treatment plant, collection network, and hospital wastewater

The current outbreak of coronavirus disease (COVID-19) has led to creating a public health emergency conditions since 2019. COVID-19, which is caused by SARS-CoV-2, is spread via human-to-human transmission by direct contact or droplets. Through conducting this study, we were looking for detecting SARS-CoV-2 in wastewater produced in Iran country (Ardabil, Nir, Khalkhal, and Kowsar) (wastewater collection network, wastewater treatment plant, and hospital wastewater). In this research, samples (n=76) were collected from influent and effluent of municipal and hospital wastewater treatment plants, and some samples were also collected from Ardabil municipal wastewater manholes. The sampling duration included the white (lower risk of COVID-19) and red (high risk of COVID-19) conditions. Samples were stored at -20 °C for further diagnostic tests. The specific primer and probe real-time reverse transcriptase-polymerase chain reaction (real-time PCR) targeting ORF1ab and N genes (nucleoprotein gene) were applied to detect viral genomes of the SARS-CoV-2 virus in the wastewater samples. Out of 76 samples, a total of 15 samples (19.73%) collected from wastewater in Ardabil province (Ardabil, Nir, Khalkhal, and Kowsar), were positive in terms of SARS-CoV-2. Wastewater epidemiology can facilitate detection of the incidence of pathogens through metropolises, measurement of population prevalence without direct testing, and provision of information to the public health system about the efficiency of intervening efforts. Graphical abstract.

Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research

Heterogeneity in the clinical presentation of SARS-CoV-2 infection and COVID-19 progression underscores the urgent need to identify individual-level susceptibility factors that affect infection vulnerability and disease severity. Tobacco product use is a potential susceptibility factor. In this Personal View, we provide an overview of the findings of peer-reviewed, published studies relating tobacco product use to SARS-CoV-2 infection and COVID-19 outcomes, with most studies focusing on cigarette smoking in adults. Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality. We discuss the potential effects of tobacco use behaviour on SARS-CoV-2 transmission and infection, and highlight the pathophysiological changes associated with cigarette smoking that could promote SARS-CoV-2 infection and increased disease severity. We consider the biological mechanisms by which nicotine and other tobacco product constituents might affect immune and inflammatory responses to SARS-CoV-2 infection. Finally, we identify current knowledge gaps and suggest priorities for research to address acute and post-acute health outcomes of COVID-19 during and after the pandemic.

Cigarette Smoking in Response to COVID-19: Examining Co-Morbid Medical Conditions and Risk Perceptions

During the initial wave of the Coronavirus Disease 2019 (COVID-19) pandemic in the U.S., information was mixed about the relative COVID-19 risks and potential benefits associated with cigarette smoking. Therefore, we sought to understand individual differences in the impact of COVID-19 on cigarette smoking in a sample of adults who reported recent use, with a particular focus on chronic medical conditions likely associated with increased COVID-19 risk. Participants completed an online survey of smoking behavior, demographic variables, medical history, and COVID-19 risk perceptions between July and August 2020 (N = 286). We examined whether medical conditions, COVID-19 risk perceptions and/or demographic characteristics were related to smoking changes in response to the pandemic (i.e., no change, decrease, increase) using multinomial logistical regression. Younger age, higher COVID-19 risk perceptions and Black versus White race were associated with greater odds of decreased smoking compared to no smoking change. Moreover, having at least one chronic medical condition was associated with greater odds of increased smoking relative to no change. The results have important implications for tobacco cessation treatment and preventive healthcare during the ongoing COVID-19 pandemic and other public health threats.

E-cigarette use among Hispanics: Reducing risk or recruiting new tobacco users?

The prevalence of cigarette smoking in the United States has been declining for over 50 years among all racial/ethnic groups. However, this progress could be stalled or even reversed by the increasing popularity of electronic cigarettes (e-cigarettes). Hispanics have experienced tobacco-related health disparities resulting from early age of cigarette smoking initiation and less success in quitting smoking. The effects of e-cigarettes on tobacco-related health disparities among Hispanics have not been well described. The uptake of e-cigarettes among Hispanic youth could lead to a "tipping point" phenomenon, in which Hispanics disproportionately become nicotine-dependent in adolescence and suffer increased tobacco-related disease in adulthood. Hypothetically, if Hispanic adult cigarette smokers switch to e-cigarettes, they could reduce (but not completely eliminate) their health risks. This article summarizes the research on the use of e-cigarettes among Hispanics. We describe the prevalence and patterns of e-cigarette use among Hispanic adolescents and adults compared with non-Hispanic whites. Findings indicate that e-cigarette use is rare among Hispanic adults, but Hispanic adolescents are at risk of experimenting with e-cigarettes at early ages, potentially leading to early nicotine addiction and exacerbating tobacco-related disparities in the future. Health education and policy interventions are needed to prevent e-cigarette use among Hispanic adolescents, while acknowledging that some Hispanic adult cigarette smokers may benefit from switching to e-cigarettes.

Latent class analysis of initial nicotine dependence among adult waterpipe smokers

Waterpipe (WP) tobacco smoking increases the risk of smoking-related health problems. In this study, we sought to identify the unobserved class memberships of WP-associated initial nicotine dependence (ND) symptoms and assess the predictors of each latent class. This cross-sectional study was conducted among a convenience sample of 900 current (past 30-day) WP smokers who were recruited from 94 WP-serving venues surrounding Tehran and Ardebil metropolitans in Iran. All participants completed a self-administrated questionnaire. We performed latent class analysis using PROC LCA in SAS to identify class memberships of initial ND symptoms using 10-item Hooked on Nicotine Checklist. Five latent classes were identified as non-dependent (25.4 %), low dependent (7.1 %), low-moderate dependent (19.6 %), moderate dependent (15.6 %), and high dependent (32.2 %). Using flavored WP tobacco significantly increased the odds of belonging to low-moderate dependent class [adjusted OR (aOR) = 1.89; 95 % confidence interval (CI): 1.07-3.34] compared to non-dependent class. Also, having academic education decreased the odds of belonging to low-moderate dependent (aOR = 0.43; 95 %CI: 0.26-0.67) and moderate dependent (aOR = 0.39; 95 %CI: 0.23-0.67) class in comparison to non-dependent class. Also, WP smoking initiation at an older age was associated with belonging to high dependent (OR = 2.05; 95 %CI: 1.39-3.03) class compared to non-dependent. This study revealed that nearly half of WP smokers fell under moderate and high-dependent classes. Our findings showed that some items of HONC had more role in the clustering of participants based on ND symptoms. The WP-specific cessation programs and targeted clinical trials should consider the diversity of ND levels among smokers to achieve successful quit rates among these smokers. Additionally, limiting flavors would be a strong strategy to limit the rate of ND, especially among young people who are eager to smoke flavored WP tobacco.

Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan

BACKGROUND

The relationship between smoking and coronavirus disease-2019 (COVID-19) is still topical with mixed epidemiological evidence. However, the pandemic may affect people's beliefs toward smoking as well as their smoking behavior and quit intentions. Considering high smoking rates in Jordan, our current study aimed to assess the following domains in a community-based sample from Jordan: (i) the beliefs that surround smoking/vaping and COVID-19 and (ii) the pandemic impact on smoking behavior and quit intention.

METHODS

A cross-sectional study was conducted in Jordan from March 9 to March 16, 2021, utilizing a web-based structured questionnaire. The questionnaire comprised 13 items on sociodemographic, health, and smoking profiles, 14 items to assess beliefs surrounding COVID-19 and the use of combustible cigarettes (CCs), waterpipe (WP), and electronic cigarettes (ECs), and 12 items to assess the pandemic impact on smoking behavior and quit intention.

RESULTS

Of 2424 survey respondents who participated in our study, there were 1163 never-smokers, 1044 current smokers, and 217 ex-smokers. The mean age of participants was 35.2 years (SD: 11.06). Most participants have reported anti-smoking beliefs with around 72.9% believed that WP smoking is related to the risk of contracting COVID-19. Also, 71.7% believed that smoking CC may worsen the COVID-19 clinical course, while 74.1% of respondents believed that smoking has no protective effect against COVID-19. During the pandemic, about 28.1% and 19.3% of current smokers reported increased or reduced smoking, respectively. Besides, 459 current smokers have expressed their plans/intention to quit smoking during the pandemic, of whom 27.5% (n = 126) confirmed that the driving force for their decision is a COVID-19-related reason, such as self-protection (n = 123) and protection of family members (n = 121) which were the most cited reasons. Also, around 63 participants have successfully ceased smoking during the pandemic. However, only 22 of them reported that the main driving motivation of their successful quit attempt was the COVID-19 pandemic.

CONCLUSION

Most participants' beliefs and attitudes were against smoking during the pandemic. Nevertheless, the double-edged effect of the pandemic on smoking habits should be carefully considered, and reliable anti-smoking measures should be strengthened and sustained in the country.

Pattern of Tobacco Use and Perceived Risk of COVID-19 Following Tobacco Use among the COVID-19 Patients of a Tertiary Health Care Institution in Eastern India

BACKGROUND

COVID-19 presented an unprecedented situation in which behavioural factors including tobacco use were believed to increase the risk of morbidity and mortality. The objective of the present study was to find the tobacco use pattern among the COVID-19 patients and the perceived risk of developing severe COVID-19 following tobacco use.

METHODS

This hospital-based, cross-sectional, analytical study was conducted among 300 COVID-19 patients at the All India Institute of Medical Sciences (AIIMS), Patna, India, during November and December 2020 using a semi-structured, pretested questionnaire. Descriptive and univariate analyses were performed using statistical software and the results were presented as proportion and percentage.

FINDINGS

About 27% and 16% of the COVID-19 patients were ever and current tobacco users, respectively. Quit attempts were found to have increased during the COVID-19 pandemic. A majority (65%) of current tobacco users had reduced their amount of tobacco use. Nearly 2 in every 3 patients perceived high risk of developing severe COVID-19 following tobacco use. Perceived risk was significantly higher among tobacco non-users, patients who were aware of the ill health effects of tobacco use, and patients who had noticed anti-tobacco messages or had been advised to quit tobacco. Among the current tobacco users, a significantly higher proportion of patients who perceived high risk of developing severe COVID-19 following tobacco use had made quit attempts or had reduced tobacco consumption during the pandemic (76.7% vs. 40%; P = 0.032).

CONCLUSION

A high proportion of COVID-19 patients believed that tobacco use aggravated the COVID-19 condition. Increased quit attempts and reduction in tobacco consumption during this pandemic is a positive sign for tobacco control.

The presence of SARS-CoV-2 in raw and treated wastewater in 3 cities of Iran: Tehran, Qom and Anzali during coronavirus disease 2019 (COVID-19) outbreak

This study aimed to identifying the presence of SARS-CoV-2 RNA in raw and treated wastewater during the COVID-19 outbreak in Tehran, Qom and Anzali cities (Iran). From three wastewater treatment plants (WWTPs), 28 treated and untreated wastewater composite samples were collected from April 4 to May 2, 2020. In this study, polyethylene glycol 6000 (PEG 6000) was used through one-step real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) for identification of RNA viruses. SARS-CoV-2 RNA was elicited from wastewater composite samples in all inlet samples taken from the three above mentioned cities. The results of outlet samples were as follows: 1) Results from Qom and East Anzali outlets showed no trace of SARS-CoV-2 RNA despite the difference in treatment disinfection method used (chlorine vs. ultraviolet (UV) disinfection). 2. In Tehran, SARS-CoV-2 RNA was not detected in any of the outlet samples taken from the modules disinfected by UV. Out of the four samples taken from the modules disinfected by chlorine, two were positive for the SARS-CoV-2 RNA which could have been caused by deficiencies in operation and maintenance. It can be concluded that meeting the standards of operation and maintenance (O&M) in WWTPs can considerably ensure that wastewater does not act as one of the roots of transmission for the disease.

The presence of SARS-CoV-2 in raw and treated wastewater in 3 cities of Iran: Tehran, Qom and Anzali during coronavirus disease 2019 (COVID-19) outbreak

This study aimed to identifying the presence of SARS-CoV-2 RNA in raw and treated wastewater during the COVID-19 outbreak in Tehran, Qom and Anzali cities (Iran). From three wastewater treatment plants (WWTPs), 28 treated and untreated wastewater composite samples were collected from April 4 to May 2, 2020. In this study, polyethylene glycol 6000 (PEG 6000) was used through one-step real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) for identification of RNA viruses. SARS-CoV-2 RNA was elicited from wastewater composite samples in all inlet samples taken from the three above mentioned cities. The results of outlet samples were as follows: 1) Results from Qom and East Anzali outlets showed no trace of SARS-CoV-2 RNA despite the difference in treatment disinfection method used (chlorine vs. ultraviolet (UV) disinfection). 2. In Tehran, SARS-CoV-2 RNA was not detected in any of the outlet samples taken from the modules disinfected by UV. Out of the four samples taken from the modules disinfected by chlorine, two were positive for the SARS-CoV-2 RNA which could have been caused by deficiencies in operation and maintenance. It can be concluded that meeting the standards of operation and maintenance (O&M) in WWTPs can considerably ensure that wastewater does not act as one of the roots of transmission for the disease.

Changes in Tobacco Use Patterns during COVID-19 and Their Correlates among Older Adults in Bangladesh

The present study explored the changes in tobacco use patterns during the COVID-19 pandemic and their correlates among older adults in Bangladesh. This cross-sectional study was conducted among 1032 older adults aged ≥60 years in Bangladesh through telephone interviews in October 2020. Participants’ characteristics and COVID-19-related information were gathered using a pretested semi-structured questionnaire. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic (6 months prior to the survey). Nearly half of the participants (45.6%) were current tobacco users, of whom 15.9% reported increased tobacco use during the COVID-19 pandemic and all others had no change in their tobacco use patterns. Tobacco use was significantly increased among the participants from rural areas, who had reduced communications during COVID-19 compared to pre-pandemic (OR = 2.76, 95%CI:1.51–5.03). Participants who were aged ≥70 years (OR = 0.33, 95% CI: 0.14–0.77), widowed (OR = 0.36, 95% CI: 0.13–1.00), had pre-existing, non-communicable, and/or chronic conditions (OR = 0.44, 95% CI: 0.25–0.78), and felt themselves at the highest risk of COVID-19 (OR = 0.31, 95% CI: 0.15–0.62), had significantly lower odds of increased tobacco use. Policy makers and practitioners need to focus on strengthening awareness and raising initiatives to avoid tobacco use during such a crisis period.