Cutting down, quitting and motivation to stop smoking by self-reported COVID-19 status: Representative cross-sectional surveys in England

Aim To examine the association of self-reported COVID-19 disease status with cutting down, past-month and past-year quit attempts and motivation to stop smoking. Design and setting Repeat cross-sectional survey, representative of the adult population in England. Participants Past-year smokers, n = 3338 (aged >= 18 years) responding between May 2020 and April 2021. Measurements Outcomes were (i) currently cutting down, (ii) having made a quit attempt in the past month, (iii) having made a quit attempt in the past year and (iv) motivation to stop smoking. The explanatory variable was self-reported COVID-19 disease status (belief in never versus ever had COVID-19). Covariates included age, sex, occupational grade, region, children in the household, alcohol use and survey month. Findings Of past-year smokers, 720 (21.6%) reported past-COVID-19 infection and 48 (1.4%) reported current COVID-19 infection. In adjusted analyses, rates of currently cutting down [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 0.93-1.34], past-year quit attempts (aOR = 0.99, 95% CI = 0.82-1.19) and motivation to stop smoking (aOR = 1.04, 95% CI = 0.89-1.23) were comparable in those who did and did not report ever having had COVID-19. People who reported ever having had COVID-19 had 39% higher odds than those without of attempting to quit in the past month, but the confidence interval contained the possibility of no difference (aOR = 1.39, 95% CI = 0.94-2.06) and for some the quit attempt may have occurred before they had COVID-19. Conclusion During the first year of the COVID-19 pandemic in England, rates of reducing smoking and attempting to quit in the past year were similar in smokers who did or did not self-report ever having had COVID-19. There was also little difference in motivation to stop smoking between groups. However, causal interpretation is limited by the study design, and there is potential misclassification of the temporal sequence of infection and changes to smoking behaviour.