During the first year of the COVID-19 pandemic — before vaccines — smokers did not smoke significantly more or less. Overall, smoking habits lessened slightly according to research published in eClinical Medicine.

The study authors searched several databases to find correlations between tobacco smoking and COVID-19 during the pre-vaccination phase of the pandemic. The study ultimately included over 269,000 participants from 24 countries. The researchers analyzed smoking prevalence as well as increased, decreased, and stable tobacco smoking during the pre-vaccination period and a period before the pandemic.

The combined prevalence ratio was .87%, which indicated a relative reduction in smoking prevalence during the pandemic. They found no relationship between smoking and COVID-19 infection and deaths per capita. The pooled estimate was highly heterogenous, however.

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Overall, 21% of the study participants smoked less during the pandemic, while 27% smoked more and 50% smoked the same amount. The results within each specific study varied widely, however.

All studies included in the analysis had a high risk of bias: either selection bias, bias due to inconsistent assessments used, or another type of bias.

“Observed decreases in smoking prevalence could be leveraged to inform tobacco control policies within individual settings to support continued decreases over time,” the researchers noted.

“Public health measures implemented during the pandemic to control COVID-19 outbreaks also represent an opportunity to study interventions that may reduce exposure to non-communicable disease risk factors, including smoking.”


Sarich P, Cabasag CJ, Liebermann E, et al. Tobacco smoking changes during the first pre-vaccination phases of the COVID-19 pandemic: A systematic review and meta-analysis. EClinicalMedicine. Published online April 12, 2022. doi:10.1016/j.eclinm.2022.101375

This article originally appeared on Psychiatry Advisor