Jackson, SE; Beard, E; Angus, C; Field, M; Brown, J; (2021) Moderators of changes in smoking, drinking and quitting behaviour associated with the first COVID-19 lockdown in England. Addiction 10.1111/add.15656. (In press).

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Abstract

Aim: To estimate changes in smoking, drinking and quitting behaviour from before to during the first COVID-19 lockdown in England, and whether changes differed by age, sex or social grade. Design: Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. Setting: England. Participants: A total of 36 980 adults (≥ 18 years). Measurements: Independent variables were survey month (pre-lockdown: August–February versus lockdown months: April–July) and year (pandemic: 2019/20 versus comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts and use of evidence-based or remote support. Moderators were age, sex and occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). Findings: Relative to changes during the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence [+24.7% in 2019/20 versus 0.0% in 2018/19, adjusted odds ratio (aOR) = 1.35, 95% confidence interval (CI) = 1.12–1.63] and quit attempts (+39.9 versus –22.2%, aOR = 2.48, 95% CI = 1.76–3.50) among 18–34-year-olds, but not older groups. Increases in cessation (+156.4 versus –12.5%, aOR = 3.08, 95% CI = 1.86–5.09) and the success rate of quit attempts (+99.2 versus +0.8%, aOR = 2.29, 95% CI = 1.31–3.98) were also observed, and did not differ significantly by age, sex or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence among all socio-demographic groups (+39.5 versus –7.8%, aOR = 1.80, 95% CI = 1.64–1.98), with particularly high increases among women (aOR = 2.17, 95% CI = 1.87–2.53) and social grades C2DE (aOR = 2.34, 95% CI = 2.00–2.74). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (aOR = 2.31, 95% CI = 1.78–3.00) but not C2DE (aOR = 1.25, 95% CI = 0.83–1.88). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. Conclusions: In England, the first COVID-19 lockdown was associated with increased smoking prevalence among younger adults and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socio-economic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE), but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).

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