The Impact of COVID-19 on Smoking Behaviours and Support for Smoke-Free Zones in Saudi Arabia

Association between COVID-19 severity and tobacco smoking status: a retrospective cohort study using propensity score matching weights analysis

INTRODUCTION

The COVID-19 pandemic continues to be a global threat to public health, with over 766 million confirmed cases and more than 6 million reported deaths. Patients with a smoking history are at a greater risk of severe respiratory complications and death due to COVID-19. This study investigated the association between smoking history and adverse clinical outcomes among COVID-19 patients admitted to a designated medical centre in Saudi Arabia.

METHODS

A retrospective observational cohort study was conducted using patient chart review data from a large tertiary medical centre in the eastern region of the country. Patients admitted between January and December 2020 were screened. The inclusion criteria were ≥18 years of age and confirmed COVID-19 infection via reverse-transcription-PCR. The exclusion criteria were unconfirmed COVID-19 infection, non-COVID-19 admissions, unconfirmed smoking status, vaccinated individuals, essential chart information missing or refusal to consent. Statistical analyses comprised crude estimates, matching weights (as the main analysis) and directed acyclic graphs (DAGs) causal pathway analysis using an ordinal regression model.

RESULTS

The sample comprised 447 patients (never-smoker=321; ever-smoker=126). The median age (IQR) was 50 years (39-58), and 73.4% of the sample were males. A matching weights procedure was employed to ensure covariate balance. The analysis revealed that the odds of developing severe COVID-19 were higher in the ever-smoker group with an OR of 1.44 (95% CI 0.90 to 2.32, p=0.130). This was primarily due to an increase in non-invasive oxygen therapy with an OR of 1.05 (95% CI 0.99 to 1.10, p=0.101). The findings were consistent across the different analytical methods employed, including crude estimates and DAGs causal pathway analysis.

CONCLUSION

Our findings suggest that smoking may increase the risk of adverse COVID-19 outcomes. However, the study was limited by its retrospective design and small sample size. Further research is therefore needed to confirm the findings.

Perceived increased susceptibility to COVID-19 due to smoking was associated with reduced smoking at home but not on the streets amid the pandemic: A population-based cross-sectional study

INTRODUCTION

Perceived risk of COVID-19 infection is associated with smoking behaviors, but the change in smoking across different settings are uncertain. We examined the associations of perceived increased susceptibility to COVID-19 due to smoking with change in smoking at home and on the streets.

METHODS

We analyzed data of 1120 current cigarette smokers aged ≥15 years from a population-based telephone survey in Hong Kong. Perceived increased susceptibility to COVID-19 due to smoking, change in smoking, intention to quit, and tobacco dependence were measured. We used Poisson regression with robust variance to estimate adjusted risk ratio (ARR) for associations, adjusting for sociodemographic characteristics, intention to quit, and time to first cigarette after waking.

RESULTS

More current smokers reduced smoking on the streets (46.1%; 95% CI: 42.8-50.0) than at home (8.7%; 95% CI: 7.0-10.8). Perceived increased susceptibility to COVID-19 due to smoking was associated with smoking reduction at home (ARR=3.29; 95% CI: 1.80-6.00, p<0.001) but not on the streets (ARR=1.13; 95% CI: 0.98-1.30, p=0.09). More smokers with stronger quit intention and lower tobacco dependence reduced smoking at home but not on the streets in those with high perceived increased susceptibility to COVID-19 due to smoking.

CONCLUSIONS

This is the first report showing that more cigarette smokers reduced smoking on the streets than at home, and the perceived increased susceptibility to COVID-19 due to smoking was only associated with smoking reduction at home but not on the streets. Improving smokers' awareness of the susceptibility to COVID-19 may be an effective strategy to reduce tobacco consumption and secondhand smoke exposure at home within the context of future respiratory pandemics.

Public support for car smoking bans in Poland: a 2022 national cross-sectional survey

OBJECTIVE

The objectives of this study were to assess the prevalence of self-reported secondhand smoke exposure in cars among adults in Poland and to characterise public attitudes towards the implementation of the ban on smoking in cars with children.

DESIGN

Cross-sectional survey was carried out between 4 March 2022 and 7 March 2022 on a national sample of 1090 adult Polish residents. The questionnaire included 12 closed questions on smoking behaviours, secondhand smoke exposure as well as attitudes towards different smoke-free laws.

PARTICIPANTS

Data were obtained from 1090 individuals, aged 18-84 years, 52.6% were females.

RESULTS

Almost every fifth respondent (17.7%) declared secondhand smoke exposure in cars in the past 30 days (31.8% of smokers and 12.0% of non-smokers; p<0.001). Lack of the implementation of smoke-free home rules (aOR 2.92, 95% CI 1.99 to 4.29; p<0.001), age 18-29 years (aOR 2.06; 95% CI 1.16 to 3.67; p=0.01), current smoking (aOR 1.99, 95% CI 1.37 to 2.90; p<0.001) as well as bad financial situation (aOR 1.60, 95% CI 1.02 to 2.48; p=0.04) were significantly associated with the higher risk of secondhand smoke exposure in cars. Out of all respondents, 84.2% supported the implementation of the ban on smoking in cars with children. Out of 12 different sociodemographic factors, only the female gender (aOR 1.94, 95% CI 1.37 to 2.74) and being non-smokers (aOR 1.70. 95% CI 1.20 to 2.41; p=0.003) were significantly associated with the higher odds of supporting the implementation of the ban on smoking in cars with children.

CONCLUSIONS

This study showed high public support for the implementation of the ban on smoking in cars with children. Social support for smoke-free environments in Poland should be used by public health specialists and policy-makers to strengthen the national tobacco control act.

A Longitudinal Study on the Addictive Behaviors of General Population before and during the COVID-19 Pandemic in China

By using nationally representative longitudinal data, this study investigates the effects of the COVID-19 pandemic on the addictive behaviors (smoking and drinking) of the general population in China. From the China Family Panel Studies (CFPS) 2018 and 2020, we extract a sample of individuals over 16 years of age in China, consisting of 14,468 individuals and 28,936 observations. We decompose the sample into three age groups, that is, ages between 16 and 39, ages between 40 and 59 and ages above 60. The bootstrap method is used to estimate the confidence interval of the difference in the mean of addictive behaviors, and logit models are used in the regression analysis. Our results show that the COVID-19 pandemic reduces the smoking behavior of individuals above 40 years of age, and that it reduces the drinking behavior of individuals above 16 years of age. However, the pandemic increases the smoking behavior of individuals between 16 and 39 years of age. These results may be closely related to the characteristics of COVID-19 (that is, a respiratory system disease), the working and economic pressures of young Chinese and the role of drinking alcohol in building and maintaining social networks in China.

Staff and student experiences and attitudes towards smoking and smoking cessation, University of Jeddah, Saudi Arabia

INTRODUCTION

Tobacco smoking causes an estimated 7 million deaths per annum with 70 thousand of those occurring in the Kingdom of Saudi Arabia (KSA) where the National Transformation Program highlights the need to prioritize smoking cessation. The objective of this study was to determine the experiences and attitudes of university staff and students, who have been or are currently smokers, towards smoking and smoking cessation.

METHODS

A link to a cross-sectional online survey was distributed by email in October and November 2020 to students and staff (n=34872) at the University of Jeddah, KSA. The survey was based on WHO GATS, CSS-21 and a systematic review. Data were analyzed using descriptive statistics in JASP (version 0.14.1) [Computer software].

RESULTS

A total of 666 responses were collected. Most respondents had never smoked (n=556; 83.5%) with some current smokers (n=72; 10.8%) and few former smokers (n=12; 1.8%). Major challenges of quitting smoking identified by the CSS-21 tool were intrinsic factors such as ‘withdrawal symptoms’ (n=28; 37.8%), ‘being addicted to cigarettes’ (n=24; 34.8%), ‘having strong emotions or feelings’ (n=28; 38.4%), and ‘seeing things or people which reminded me’ (n=25; 34.2%). The extrinsic factors were mostly reported as ‘not a challenge’, such as ‘use of other substances like cannabis, alcohol, etc.’ (n=60; 87.0%) or ‘lack of support or encouragement from health professionals to stop smoking’ (n=50; 69.4%). Many staff and students were ‘asked if you smoked tobacco products’ at a healthcare professional appointment with (n=5; 83.3%) and (n=27; 71.1%), respectively. Both staff (n=6; 75.0%) and students (n=19; 34.5%) thought ‘face-to-face counselling’ would help support their future attempts to quit.

CONCLUSIONS

The majority of smokers who participated saw intrinsic factors more of a challenge than extrinsic factors. This new knowledge has the potential to influence decision makers. There is potential for encouraging healthcare practitioners to promote smoking cessation conversations.