Fewer requests for smoking cessation services during COVID-19 pandemic

During the COVID-19 pandemic, requests for smoking-cessation services were down 27%, according to new data from the North American Quitline Consortium.

The decrease in requests for smoking-cessation support correlates with the increase in cigarette use reported by the U.S. Treasury Department, a marked change from years of steady decline, according to a press release from the North American Quitline Consortium.

“COVID-19 has rebalanced the progress we have made on smoking cessation, but we know that we can turn around this trend and start making progress again in 2021 if we pay attention to making people aware of the risk and making them aware of services to help them,” Linda Bailey, JD, MHS, president and CEO of the North American Quitline Consortium, said during a media briefing.

Decline in smoking-cessation requests

According to the CDC, U.S. smoking rates decreased from 42% in 1965 to 25% in 1997 and 14% in 2019. However, current smoking rates demonstrate that cigarette sales increased by 1% in the first 10 months of 2020 after decreasing 4% to 5% annually since 2015, according to the release.

“The U.S. surgeon general has conclusively linked smoking to the suppression of the immune system,” Anne DiGiulio, national director of lung health policy at the American Lung Association, said during the briefing. “According to CDC, smoking increases the risk of illness from the virus that causes COVID-19. In light of this, quitting has never been more important.”

The North American Quitline Consortium report examined data calls made to quitlines through 1-800-QUIT-NOW from 53 U.S. states and territories in the U.S. The quitlines provide callers information, counseling and medications to aid smoking cessation.

Since 2012, calls made to quitlines ranged from approximately 700,000 to more than 900,000 per year. However, during the COVID-19 pandemic, requests for smoking-cessation services were substantially decreased to 525,609 calls in 2020, a 27% decrease from 2019, according to the report.

Further, in 2020, there was a 6% decrease in smoking-cessation calls from January to March, a 39% decrease from April to June, a 30% decrease from July to September and a 21% decrease from October to December.

Throughout 2020, 20 U.S. states reported spreading messages about smoking cessation during the pandemic. In these states, empathetic messages, messages aimed to help and encourage smoking cessation instead of placing blame, and messages describing availability of smoking-cessation services were most well received, according to the report.

“The decline in smoking rates has been uneven across American society,” Matt Pierce, program officer at the Robert Wood Johnson Foundation, said during the briefing. “Targeted marketing, continued sale of menthol cigarettes and other flavored tobacco products and unequal access to cessation services are among the barriers that have resulted in commercial tobacco products disproportionately harming people with lower incomes and less education, people who identify as lesbian, gay, bisexual and/or transgender, many communities of color, and people with mental illness and substance use disorders.”

Impact of smoking and mental health

The COVID-19 pandemic has increased rates of stress and anxiety for many, including those who smoke.

“We believe that ... stress and anxiety have also contributed to the decrease in people seeking help to quit tobacco use,” Bailey said.

According to Catherine Saucedo, deputy director of the Smoking Cessation Leadership Center at University of California, San Francisco, although most smokers are aware of the added risks with COVID-19 and smoking and most report interest in quitting or reducing their tobacco use, about one-third of smokers increased their tobacco intake in the last year due to higher levels of stress related to the pandemic. The increase in smoking related to COVID-19 and the decline in smoking cessation access has an intense and immediate effect because smoking cessation can worsen depression and anxiety, which can also complicate recovery from other mental health and substance use disorders, she said.

“The pandemic took the big basket of anxieties, depression and addiction that we have in the U.S. and, for smokers, it put that basket on steroids,” Saucedo said in the release. “Even though smoking has been shown to make all these bad things worse, people stopped trying to quit. We need to recapture the momentum we had and, once again, save lives. We know how to do this.”

Moreover, in a CDC survey conducted in the summer of 2020, around 2 in 5 Americans report significant mental health symptoms.

“We have had more people contacting the helpline, more people seeking support, more people engaging with us than ever before because there’s so much recognition of the increased rates of anxiety, depression, isolation, and for people who have serious conditions, difficulty accessing services in person,” Ken Duckworth, MD, chief medical officer at the National Alliance on Mental Illness, said during the briefing.

Strategies to improve access

Increasing access to smoking-cessation services has been important during the pandemic, according to the speakers.

“The COVID-19 pandemic underscores the importance of quitting smoking and making sure smokers have access to proven quit-smoking treatments,” DiGiulio said. “The decrease in calls to the quitline last year is a disturbing development and we are working with our partners to help understand and reverse this trend.”

Steps have been made to overcome the challenges and barriers posed by the COVID-19 pandemic. Pierce highlighted several policy changes that the American Lung Association has supported to help smokers quit during the pandemic and help them overcome some of the unique challenges posed by the pandemic. Due to many nonemergency medical appointments canceled during the pandemic, the expansion of telehealth allows patients to access medical appointments, including smoking-cessation counseling and treatment. Also, some U.S. states have lifted telehealth restrictions for Medicaid and private insurance. Due to overwhelming job losses during the pandemic, many states reopened state exchange open enrollment for those who are unemployed without insurance. Finally, President Biden signed legislation to expand premium tax credits for more affordable health insurance coverage. Moreover, some states have expanded Medicaid programs to provide smoking cessation benefits for low-income residents, which the American Lung Association encourages other states to do the same to provide health care for the 2.2 million individuals in the coverage gap, he said. This is notable, as data demonstrates that uninsured people have a more than double smoking rate compared with those who are privately insured, he said.

To address the problem of mental health and smoking, the Smoking Cessation Leadership Center created “I COVID QUIT,” released at the end of March, a social media campaign of former smokers who tell their own stories of smoking cessation to spread the word of the benefits to quitting smoking in improving both an individual’s physical and mental health.

In addition, “because of COVID-19, the American Society of Addiction Medicine continues to advocate for bold structural changes that fortify our ability to build a steady workforce of clinicians who can help prevent and treat substance use disorders,” Brian Hurley, MD, director of the American Society of Addiction Medicine board of directors and incoming president-elect, said during the briefing. “We support standardizing the delivery of individual addiction care, particularly including smoking cessation, and to provide consistent and adequate health insurance coverage for individuals with substance use disorders, particularly including tobacco use disorder, and to provide appropriate reimbursement for clinicians who treat them.”

References:

Press Release.
North American Quitline Consortium report.