Worry about COVID-19 in relation to cognitive-affective smoking processes among daily adult combustible cigarette smokers

The global Coronavirus 2019 (COVID-19) pandemic is colliding with mental and physical health comorbidities. Tobacco use persists as the global leading cause of preventable death and disability and is associated with an increased risk for cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension – conditions thought to exacerbate COVID-19 symptom severity. Additionally, early research suggests that smoking is a likely risk factor for COVID-19 disease progression. Compounding the physical health concerns related to COVID-19 and cigarette smoking, the COVID-19 pandemic has been conceptualized as a generalized stressor. This is especially troublesome as one identified reason for continued cigarette smoking is to manage stressful states. Since the COVID-19 pandemic is ongoing and pervasive, it is important to better understand the relationship between stress related to COVID-19 and smoking behaviors.

One factor which may be especially pertinent to COVID-19 and cigarette smoking is worry. Worry is conceptualized as future-oriented thoughts that are repetitive and catastrophic and may be an especially important the context of stress related to COVID-19. Current assessments of worry about COVID-19 focus on contracting the virus, health-related symptoms, virus transmission, and concerns about access to care. Accordingly, increased pandemic-related stress and subsequent worry about COVID-19 may amplify the desire for an individual to alter their smoking behavior. Yet, more work is needed to better understand the link between worry about COVID-19 and reasons for smoking, perceived barriers to smoking cessation, and beliefs about the anticipated effects of smoking abstinence

To explore how worry about COVID-19 relates to clinically relevant facets of smoking behavior, data were collected from 219 daily adult combustible cigarette smokers in June 2020. We anticipated that greater levels of worry about COVID-19 would be associated with increased COVID-19 coping motives for smoking, more perceived barriers for smoking cessation, and elevated abstinence expectancies for negative mood, somatic symptoms, and harmful consequences. Overall, the findings supported our hypotheses and provide initial evidence that worry about COVID-19 may be a risk factor for continued combustible cigarette smoking in the context of the COVID-19 pandemic.

The present findings have important clinical implications and suggest that COVID-19 worry may be involved in the maintenance and relapse of smoking. If replicated and extended using longitudinal assessment, COVID-19 worry may represent a clinically important individual factor among adults that should be assessed and integrated as a focus of health promotion and smoking cessation treatment. Indeed, it may be beneficial to utilize COVID-19 worry as a potential screening mechanism within primary care or dental settings for smokers who may be at risk for more problems in changing their smoking behavior. In doing so, these COVID-19 worry concerns may be identified and treated through integrative mental health-smoking protocols.

Read the full paper: Shepherd, J. M., Fogle, B., Garey, L., Viana, A. G., & Zvolensky, M. J. (in press). Worry about COVID-19 in relation to cognitive-affective smoking processes among daily adult combustible cigarette smokers. Cognitive Behaviour Therapy. doi:110.1080/16506073.2020.1866657

Photo By: Ivan Radic

Pictured: Justin Shepherd

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