Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Intervention
2.3. Data Collection Process
2.4. Qualitative Analysis
3. Results
3.1. Theme 1: Effect of COVID-19-Induced Environmental Changes on Smoking Behaviors
3.1.1. Negative Effect of Environmental Changes on Smoking Behaviors
“I think what happened was I was just getting so bored that—when you’re bored, what do you do? You eat, and I smoke. I don’t drink. I don’t do drugs. But that was my out. I was reading 10 books a week, and you get bored, and you get up and you have a cigarette” [A, under 55, not quit].
“The coronavirus forced me to stay home from work a lot more than I usually do and not always having a lot to do. Sitting around watching some TV or working around the house outside, I had more freedom, and it was easier to smoke and not be around many people” [B, under 55, not quit].
3.1.2. Positive Effects of Environmental Changes on Smoking Behaviors
“Well, if I went out, I would have the mask on so I wouldn’t smoke a cigarette” [C, under 55, not quit].
“I would think it would be harder if the coronavirus wasn’t around because. I’m not going out to a pub, not meeting with my friends” [D, over 55, not quit].
3.2. Theme 2: Pandemic-Induced Stress and Smoking
“The fact that I’m not working and the pandemic, obviously, didn’t really help because it’s a very stressful time. So I was thinking to myself, ‘Is this the right time to even try (to quit),’ considering that I do have all this added problematic situation and stress” [E, under 55, quit].
“I think considering the stressful nature of the world right now, I think it was a fairly successful attempt to quit. Just another factor in the pandemic and how it affects me is I work at [grocery store]. And right now, because of the pandemic, work is much more stressful than it is normally, unfortunately. So, I think it’s another reason that made it harder to quit” [F, under 55, not quit].
“I’ll walk around that grassy area five times to get the mile in now, and that seems to de-stress me, but I only do that when there’s no people out there. Everybody’s out there trying to stretch, so I just make sure it’s at a time when there’s nobody out there. And then I do the stretching—I learned I forget what it’s called body shape or body stretch or something. It’s not so much to lose weight as it is to just stretch. So I’ll do that in the apartment also to not smoke, but I got to be honest with you and tell you that I really rely on those lozenges” [G, over 55, quit].
3.3. Theme 3: No Increased Risk of Being Infected Due to Smoking
“Well, I think it’s transmitted from person to person, not from cigarettes” [H, over 55, not quit].
“This might sound funny, but I was talking to somebody who runs an area in the hospital when all this first started, and that guy didn’t even know that I smoked, but he said to me and another guy in conversation that—he said, ‘Do you know that smokers are less likely to get coronavirus because their lungs have a buildup in them [laughter]?’ That’s something that come out of somebody’s mouth, and it kind of shocked me. I don’t know where he got the information from, but it was something that stuck with me” [I, under 55, not quit].
3.4. Theme 4: Perceived Increased Risk of Poor Outcomes Due to Smoking If Infected with COVID-19
“Did the coronavirus make you want to quit more or less or no change?” [Interviewer].
“It definitely did because it’s a respiratory infection. And people that are longtime smokers or have asthma are more prone to have more crippling sicknesses if they do get it. So I think that that was in the back of my mind. I mean, the coronavirus is scary. I don’t care what anyone says. It’s really scary. If you are young and you have no high risk, then I can see where it would be less scary if you get it. You can get through it at home, and then you’ll be fine afterwards. And if you’re more high risk, it’s kind of roulette. You don’t know what’s going to happen” [E, under 55, quit].
3.5. Theme 5: Different Patterns of Impacts of COVID-19 on Smoking Behaviors
3.5.1. Age and Response to COVID-19 Influenced Reactions to the Texts
“They were just amazingly uplifting to me in my life in trying to quit, more than just relying on friends and family and so on and so forth” [J, under 55, quit].
“I have to be isolated because of my cancer and heart problems, so every time that the bell went off that I was receiving a text message, I should tell you the truth, I honestly thought it was someone that cared for me in my family or a doctor or something like that, and it got to be almost moronic” [L, over 55, not quit].
3.5.2. Age Differences in Quitting Behaviors during COVID-19
“I say the coronavirus gave me the opportunity to protect myself from two different health things. One, from coronavirus, and one, to want to live long and live healthy. It gave me time to sit and meditate and self-reflect” [M, under 55, quit].
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Participant Sample N = 22 | |
---|---|
n (%) | |
Gender | |
Female | 12 (54.5) |
Age | |
Years—Mean [SD] | 54.7 [14.4] |
Under 55 | 11 (50) |
55 and over | 11 (50) |
Race | |
American Indian, Alaska native | 1 (4) |
African American | 2 (9.1) |
White | 18 (81.8) |
Other | 1 (4.5) |
Insurance | |
Medicare | 4 (18.2) |
Medicaid/Masshealth | 13 (59.1) |
Employer | 7 (31.8) |
Other state or local | 1 (4.5) |
Individual | 1 (4.5) |
Mental Health | |
PHQ-2 ≥ 3 1 | 4 (18.2) |
GAD-2 ≥ 3 2 | 11 (50) |
Nicotine Dependence | |
Low Nicotine Dependence ≤ 2 3 | 14 (63.6) |
Moderate Nicotine Dependence ≤4 3 | 7 (31.8) |
High Nicotine Dependence >5 3 | 1 (4.5) |
Subthemes | Summary of Theme | Supporting Quotation |
---|---|---|
Differences in impacts of COVID-19 on Smoking | Younger participants experienced more stress during this time which made it harder for them to quit. | “So quitting smoking is stressful. And then I had extra stress added on to try to keep my family safe and me safe, and I think that was definitely the issue. I think if the virus wasn’t here, and I had the text messaging, I definitely would have stopped because I stopped for longer period of time than I ever. So I think it was just the timing that it involved” [A, under 55, not quit]. “I don’t know if it’s just stress with everything that’s going. If these, I think, other outside factors weren’t involved, it might have gone a little better for me” [M, under 55, not quit]. |
Older participants struggled with boredom and isolation which led them to smoke more. | “I think having to stay at home affects it. Social distancing really doesn’t…Because it’s boring. Nothing to do and you have a smoke” [H, over 55, not quit]. “Oh, well, because I’m sitting here, and I’m bored, so it’s affected it a lot because, like I said, I can’t keep myself busy enough When I quit drinking, it was the same thing. I had to find things to do to break up your normal thing you would do that would make you want to have a drink. It’s the same thing with cigarettes. You want to change things so that you can quit. When you can’t, well, it’s making it harder” [N, over 55, not quit]. | |
Age and response to COVID-19 influenced reactions to the texts. | Older participants who were struggling with COVID-19 environmental changes did not enjoy the text messages. | “I think one of the things that I did sort of feel about it, was the text messages in the last month or so were more of a kind of you-failed-every-day sort of thing. Like, “Did you use the patch or the gum?” No. No. No. And it was more like fail, fail, fail, which, in context of everything else that’s going on, was kind of a bummer” [O, over 55, not quit]. “I think the texting was an interesting idea. But, obviously, they were not done that were appropriate for the time what we’re all going through with the COVID, and it was not a person doing it, it was a machine doing it” [J, over 55, not quit]. |
Younger participants more often had a positive reaction to the text messages. | “From the text messages, I got used to receiving them every day, very much so. They got me very encouraged. It made me feel very empowered as a person to want to quit smoking. And that was one of the things that I was so excited about, to receive text messages. Maybe it wasn’t a call from somebody, but the text messages were very empowering, very strong, and very wonderful to hear and see each morning on different things and different ways that I can use on quitting smoking” [I, under 55, quit]. | |
Age differences in quitting behaviors during COVID-19 | Older participants more often mentioned that COVID-19 had no impact of their motivation to quit. | “It made no difference whatsoever” [G, over 55, quit]. “No, they are pretty much the same benefits [of quitting]” [O, over 55, not quit]. |
Younger participant had a more positive outlook and were more motivated to quit | “I just kind of figured I’m in my house. I’m not going out. I’m trying to save money. I almost felt like it would be easier in some sense to actually quit now” [E, under 55, quit]. |
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Joyce, A.A.; Styklunas, G.M.; Rigotti, N.A.; Neil, J.M.; Park, E.R.; Kruse, G.R. Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 1011. https://doi.org/10.3390/ijerph18031011
Joyce AA, Styklunas GM, Rigotti NA, Neil JM, Park ER, Kruse GR. Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2021; 18(3):1011. https://doi.org/10.3390/ijerph18031011
Chicago/Turabian StyleJoyce, Andrea A., Grace M. Styklunas, Nancy A. Rigotti, Jordan M. Neil, Elyse R. Park, and Gina R. Kruse. 2021. "Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 18, no. 3: 1011. https://doi.org/10.3390/ijerph18031011