The Pandemic Smoking Divergence: Why Some Smokers Quit During COVID—and Others Smoked More

In March 2020, as the COVID-19 pandemic reshaped daily life across the globe, smoking behavior diverged along two trajectories. Some smokers quit—motivated by the evidence (emerging but plausible) that smoking increased the risk of severe COVID-19 outcomes, by the disruption of smoking routines during lockdown, or by the sudden awareness of respiratory vulnerability that the pandemic induced. Other smokers increased their consumption—driven by the stress, anxiety, and social isolation of the pandemic, by the loss of workplace smoking restrictions (working from home meant smoking at the desk), or by the substitution of cigarettes for the other coping mechanisms (social interaction, physical activity) that the lockdown had eliminated. The divergence was not random. It mapped onto the socioeconomic gradient of smoking with uncomfortable precision: the smokers who quit were disproportionately affluent, educated, and employed in jobs that could be done remotely; the smokers who increased their consumption were disproportionately low-income, less-educated, employed in essential frontline jobs, and already carrying the heaviest burden of smoking-related disease.

The pandemic's impact on smoking behavior was, in many ways, a natural experiment that tested the determinants of smoking at a population scale. The lockdown disrupted the cues and routines that sustain smoking—the smoke break at work, the cigarette with colleagues, the social smoking at bars and restaurants. For smokers whose smoking was primarily cued by these external triggers, the disruption created an opportunity to quit. The lockdown also intensified the stress and isolation that smoking is used to manage—the anxiety about health and finances, the loneliness of social distancing, the monotony of confinement. For smokers whose smoking was primarily driven by these internal states, the pandemic made smoking more necessary, not less. The divergence between quitters and escalators was a natural experiment in the heterogeneity of smoking motivation—a demonstration that 'smoking' is not a single behavior with a single set of causes, but a category that contains multiple behavioral phenotypes with different drivers and different responses to environmental change.

The public health response to the pandemic's impact on smoking was largely reactive rather than strategic. Some countries (the UK, New Zealand) integrated smoking cessation into their COVID-19 public health messaging, emphasizing that quitting smoking was one of the most effective things a smoker could do to reduce their COVID-19 risk. Other countries (the US, much of the EU) did not, treating smoking as a pre-existing condition that was relevant to COVID-19 outcomes but not as a behavior that could be modified during the pandemic. The availability of cessation support during the pandemic varied by country: the UK's NHS maintained and in some cases expanded remote cessation services (phone, video, digital); other countries saw reductions in cessation support as healthcare resources were redirected to the COVID-19 response. The pandemic was both an opportunity to accelerate smoking cessation (by leveraging the heightened awareness of respiratory vulnerability) and a threat to smoking cessation (by disrupting the support infrastructure and increasing the stress that drives smoking). The public health community's response was, on balance, more reactive than strategic—an understandable response to an unprecedented crisis, but a missed opportunity nonetheless.

The pandemic's impact on the nicotine product market was significant and potentially lasting. Vape shops, classified as non-essential businesses in most jurisdictions, were closed during lockdowns—a disruption that disproportionately affected the independent vaping sector (small businesses) while benefiting the convenience-store and online channels where the major tobacco companies' products (Vuse, IQOS) are distributed. The disposable vape boom—which accelerated during the pandemic—was partly a response to the disruption of the vape-shop channel: consumers who could no longer visit vape shops for refillable products turned to the disposable products available at convenience stores and gas stations. The pandemic accelerated the consolidation of the vaping market around the major companies and the disposable format—trends that were already underway but that the pandemic intensified. The long-term consequences of this market restructuring are still unfolding, but the direction is clear: the pandemic made the nicotine market more concentrated, more convenience-oriented, and more dominated by the major cigarette companies' alternative products.

The equity dimension of the pandemic smoking divergence is the most important and least discussed. The smokers who increased their consumption during the pandemic were the smokers who were already carrying the heaviest burden of smoking-related disease—low-income, less-educated, working in frontline jobs that exposed them to both COVID-19 risk and smoking triggers. The smokers who quit were the smokers who were already more likely to quit in any circumstances—affluent, educated, with access to cessation support and the resources to manage the stress of quitting. The pandemic did not create the inequality in smoking outcomes. It amplified an inequality that was already structurally embedded in the socioeconomic gradient of smoking. The lesson for tobacco control is that the policies that work for the general population—cessation support, public health messaging, environmental restrictions—have differential effects across the socioeconomic spectrum, and the populations that need the most support are the populations that the existing support infrastructure is least able to reach. Closing that gap requires more than pandemic-responsive messaging. It requires a fundamental reorientation of tobacco control toward the populations that are carrying the heaviest burden of the epidemic.

The pandemic smoking divergence is also a cautionary tale about the limits of individual behavior change as a public health strategy. The public health message during the pandemic—'quit smoking to reduce your COVID-19 risk'—was accurate but insufficient. It placed the burden of risk reduction on the individual smoker, without addressing the structural conditions that made quitting harder for some smokers than for others. The message assumed that smokers could quit if they were sufficiently motivated—an assumption that decades of smoking cessation research have demonstrated to be false for the majority of smokers. The alternative approach—making safer nicotine products accessible and affordable as an alternative for smokers who cannot or will not quit, while providing cessation support for those who want it—is the approach that the countries with the best pandemic smoking outcomes (the UK, New Zealand) had already adopted. The pandemic did not validate the abstinence-only approach to smoking cessation. It validated the harm-reduction-plus-cessation approach that the abstinence-only advocates had spent decades opposing.

Shareable insight: The pandemic split smokers into two groups: those who quit (disproportionately affluent and educated) and those who smoked more (disproportionately poor and frontline workers). The split didn't create inequality in smoking outcomes—it amplified the inequality that was already there. The lesson for tobacco control is that the populations that need the most support are the populations the existing system is least able to reach.