Behavioral Health During the Pandemic
The COVID-19 pandemic has significantly impacted all our lives. Varying responses to the stress of the pandemic have led to behavior changes. Restrictions on travel and visitations due to social distancing have magnified depression and isolation in some. In others, it may have contributed to anxiety over the constant threat of contracting the illness. During the period from August 2020 to February 2021, there was a notable increase of adults with recent symptoms of anxiety or a depressive disorder from 36.4% to 41.5%.1 Large disease outbreaks have been associated with mental health problems that stem around fear and grief but unfortunately, there was an additional increase in unmet mental health care from 9.2% to 11.7%.1
Smoking Behavior During the Pandemic
As smoking is often cited by current smokers to be a stress coping activity, it actually isn't a true stress reliever. It is important to point out that nicotine addiction is what causes stress on the body and cravings are stressful because your body starts to go through withdrawal. This is why it can be difficult to quit as individuals mislabel smoking as a stress coping behavior when instead, every time they light up they are starting the stress cycle again.
Quitting smoking is an extremely difficult thing to do even when your life feels stable, where the pandemic may have limited motivation to quit. Specifically, the constraints imposed to limit the spread of COVID-19 might have had mixed effects on smoking cessation. Loss of income might have contributed to smoking less or could have increased it as a coping strategy to deal with the stress of loss of job or income. Due to social distancing, smoking for socializing with peers or coworkers might not have been feasible and related to fewer smoking behaviors. On the other hand, working from home may have led people to smoke more as they were free to take smoking breaks more frequently than while they were in the office.
Youth might have specifically been impacted by the pandemic as they often share their vaping products and might not have been able to purchase or use vaping products as much while being stuck in their home environments due to in-person school activities being suspended. Additionally, this may have been beneficial in slowing the spread of COVID-19 in youth that smoke as vaping involves hand to mouth transmission and this population is known to share products.
National Quitline Rates Decline
The U.S. Centers for Disease Control and Prevention established the national portal, 1-800-QUIT-NOW, to help promote state quitline services. The annual call volume usually ranges between 700,000 to 900,000 calls.2 According to an analysis conducted by the nonprofit North American Quitline Consortium (NAQC), the quitline portal experienced a 27% drop in call volume in 2020. 2 Specifically, the portal received about 190,000 fewer calls last year than it did in 2019. The 525,609 calls marked the lowest volume since 2007.2
Not only was there an overall decrease in call volume in 2020, but the NAQC report also noted that the decline appeared to mimic the timeline of the pandemic. The largest drop in call volume (39%) occurred in the three-month period from April to June where many states had imposed lockdowns and when infections and deaths were skyrocketing.2 Calls continued to decline by substantial amounts throughout the remainder of the year. These data indicate that the COVID-19 pandemic has had a large and negative impact on smoking cessation in 2020.
The president and CEO of NAQC commented during an interview with the Washington Post that Quitline counselors have reported anecdotally that smokers who called during the pandemic seemed to need much more emotional support and were less confident they would be able to quit than callers before the pandemic. 3 Additionally, she reported that quitlines also received calls from former smokers who were feeling anxious with concerns that they would relapse. 3
Looking Forward Utilizing Resources
During the first quarter of 2021 (January 1 - March 31), 141,770 calls were made to state quitlines through 1-800-QUIT-NOW. 4 This is a 9.7% increase in call volume compared to the first quarter of 2020 and 2.8% increase compared to 2019. 4 This increase in call volume might be attributed to the large increase in calls during March as the CDC Tips from Former Smokers campaign celebrated it’s 10th anniversary with new ads and the ICOVIDQUIT campaign was launched. 4,5 The Tips campaign is the nation’s first federally funded tobacco education campaign while the ICOVIDQUIT campaign is one of the most recent campaigns. 5 The second quarter of 2021 (April 1 - June 30) will be a critical time to recoup the ground that was lost in 2020, when call volume to quitlines was down.
The new ICOVIDQUIT social media campaign is a new resource that behavioral health providers can use to help motivate smokers to quit. It was created with the mindset to use social marketing to create behavioral change by involving community stakeholders to get community input as they will know more about change and social norms. It focused on creating materials to catch people on an emotional level. 6 These messages were meant to be compelling, evoke emotions, and emphasize healthy behavior change so that they would capture the target audience’s attention across the nation. 6
The campaign defined its target audience as tobacco smokers living with behavioral health conditions, with a focus on communities of color and lower socioeconomic groups. 6 It then recruited individuals with behavioral health conditions to explain their experiences of quitting smoking during COVID-19 using unscripted interviews to make the messages as authentic as possible.6
The social media toolkit enables social sharing of images, ensures a cohesive message by providing suggested captions, and elevates website traffic and the number of calls to quitlines by using hashtags. The resources developed by the ICOVIDQUIT campaign should continue to be promoted and shared to help reduce the high rates that have been noted. Increasing efforts to implement these messages while continuing to offer smoking cessation services is vital to ensure progress can be made. Health care professionals need to be aware that smoking is not just naturally decreasing and needs to constantly be a priority for healthcare professionals.
- Vahratian, A., Blumberg, S.J., Terlizzi, E.P., Schiller, J.S. (2021). Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 Pandemic United States, August 2020-February 2021. Morbidity and Mortality Weekly Report, 70(13), 490-494. DOI: http://dx.doi.org/10.15585/mmwr.mm7013e2
- North American Quitline Consortium. Report on the Impact of the COVID-19 Pandemic on Smoking Cessation. (Editors: L. Bailey and K. Mason). March 2021. Phoenix, AZ
- Chiu, A. (2021, March 12). Fewer smokers seem to be trying to quit during pandemic, report finds. The Washington Post. https://www.washingtonpost.com/lifestyle/wellness/smoking-help-quit-cigarettes-covid/2021/03/12/333936ee-82c2-11eb-ac37-4383f7709abe_story.html
- Gromov, N. (2021). Good news on quitline utilization in 2021! Northeastern American Quitline Consortium Newsroom. Retrieved from: https://www.naquitline.org/news/559572/Good-News-on-Quitline-Utilization-in-2021.htm
- CDC. (2021, March 1). CDC’s Tips From Former Smokers® Campaign Returns With New Ads. Retrieved from: https://www.cdc.gov/media/releases/2021/p0226-former-smokers-tips.html
- University of California San Francisco (UCSF) Smoking Cessation Leadership Center (2021). I COVID QUIT. Retrieved from: https://smokingcessationleadership.ucsf.edu/icovidquit