COVID-19 and Tobacco Cessation—Evidence from India | Sara Bardhan

Sara Bardhan was a fellow with YAT Fellowship (July – August, 2022). The fellowship aimed at increasing youth engagement in the tobacco control space by creating impactful narratives & knowledge products to raise awareness on the issue of tobacco consumption. As part of the fellowship, Sara worked on understanding Tobacco Cessation from the lens of policy & technology with Manbhum Ananda Ashram Nityananda Trust (MANT).

The COVID-19 pandemic shocked the world’s health-systems, destabilised economies and presented unprecedented challenges to the physical and mental health of individuals—especially in developing and underdeveloped countries. Notably, India recorded one of the highest COVID-19-related infection rates in the world with over 2.5 million confirmed cases and a devastating death toll [1]. While COVID-19 poses critical health challenges to all, recent evidence shows that tobacco users are at an increased risk of adverse outcomes [2] and have a higher likelihood of COVID-19-related complications, including mortality [3].

Since a significant proportion of smokers have pre-existing comorbidities such as Chronic Obstructive Pulmonary Disease (COPD), hypertension, diabetes and heart-related conditions, contracting a COVID-19 infection may heighten the risk of complications [4,5]. Moreover, consuming tobacco usually involves contact between fingers and the mouth and smokeless tobacco products (SLT) induce salivation and, therefore, spitting—both of which can potentially facilitate the exposure of a COVID-19 infection [6,7]. 

Consequently, a number of countries adopted stringent tobacco control measures during the peak of the pandemic to control the risks posed by the use of tobacco products. For example, Bangladesh suspended the production, supply, marketing, and sale of all kinds of tobacco products, South Africa restricted the sale of tobacco-related products, and Botswana banned the import and sale of cigarettes and other related products [8,9,10].

Among them, India too issued a slew of warnings and advisories on the national level followed by subsequent state-level policies to warn against the use of tobacco [11]. The use of smoking and spitting, especially in public places, was prohibited by the the Indian Council of Medical Research (ICMR) and the Ministry of Health and Family Welfare, Government of India [12]. Considering this, the Ministry of Home Affairs, Government of India prohibited the sale and use of gutkha and other tobacco products in the country [13]. 

It is clear that, reinforced with government policies, the pandemic created a nationwide conducive environment for tobacco cessation—putting most users in a ‘cold-turkey’ predicament. Since users were forced to abstain and isolated from their social circles where tobacco consumption is the norm, scholars and practitioners speculate that those who are keen might be more receptive to cessation interventions and advice and find it easier to quit than before.

In addition, the pandemic is likely to restrict access to tobacco products among adolescents and young adults [14]. Moreover, evidence from around the world which report a stimulated interest in reducing or quitting tobacco during the pandemic [12,15,16]. Such speculations are further confirmed when we take a gander at latest data which indicates that tobacco sales took a hit during the pandemic in India [17]. 

Nevertheless, COVID-19 has also triggered an increase in anxiety, stress, irritability, and mood swings which may lead to a relapse for tobacco users who may resort to black marketing or illegally procuring tobacco products. Taking this into account, the Indian Minister of Health and Family Welfare particularly emphasised stress management and quitting tobacco via its central and state helplines and followed it by publishing audio-visual materials about COVID-19 in English and Hindi [18]. 

It is obvious that the pandemic has created fertile ground for cessation activities to take off and the government’s efforts to escalate cessation efforts could potentially pay off considerably. A 2020 study noted that nearly two-thirds of tobacco users in India reported a reduction in tobacco use and intention to quit and thus, building digital tobacco cessation services to reach out to smokers directly is key [19].

Strengthening teleconsultation and telemedicine facilities, app-based cessation interventions and subsidising Nicotine Replacement Therapy (NRT) can help users quit [14,20] along with offering accessible, comprehensive, tailored, multilingual cessation advice and counselling services via mass media to build better health literacy [21,22]. 

Even though existing evidence suggests that restricting the availability of and access to tobacco products limits tobacco use [23,24], it is perhaps too early to comment on the impact of restricting tobacco trade, sale and use during and after the peak of COVID-19 in India due to the absence of large-scale, longitudinal data about abstinence, withdrawal and relapse among tobacco users.

It is also key to point out that tobacco sales, which had dipped during the pandemic, have exceeded pre-pandemic levels and have returned to near-normal retail [17]. Nevertheless, on the basis of evidence that has been collected through small-scale studies over the pandemic, it is clear that it is an opportune moment for the Indian government to strengthen its cessation activities to directly reach out to tobacco users and nudge them towards quitting behaviour through bespoke cessation advice.

Author – Sara Bardhan


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