Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data

Abstract

Aim: To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England.

Design/setting: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown.

Participants: A total of 20 558 adults (≥ 16 years).

Measurements: The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant).

Findings: The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (OR_adj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, OR_adj = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, OR_adj = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, OR_adj = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, OR_adj = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, OR_adj = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, OR_adj = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, OR_adj = 1.32, 95% CI = 0.64-2.75).

Conclusions: Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.

Keywords: Alcohol; COVID-19; SARS-CoV-2; alcohol reduction; drinking; quit attempts; smoking; smoking cessation.

Figure 1

Prevalence of (a) current smoking among all adults, (b) cessation and (c) quit attempts by past‐year smokers; (d) use of evidence‐based cessation support and (e) use of remote cessation support by past‐year smokers who made a quit attempt in England, April 2019–April 2020. The dotted line indicates the timing of the COVID‐19 lockdown in England. Data for March 2020 were imputed as the average of February and April 2020 on the basis of presumed linear change

Figure 2

Prevalence of (a) high‐risk drinking among all adults, (b) reduction attempts by high‐risk drinkers, and (c) use of evidence‐based support; and (d) use of remote support for alcohol reduction by high‐risk drinkers who made a reduction attempt in England, April 2019–April 2020. The dotted line indicates the timing of the COVID‐19 lockdown in England. Data for March 2020 were imputed as the average of February and April 2020 on the basis of presumed linear change