COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran

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ENVIRONMENTAL FACTORS AND THE EPIDEMICS OF COVID-19

COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran Mohammad Ebrahimi Kalan 1 & Hassan Ghobadi 2 & Ziyad Ben Taleb 3 & Davoud Adham 4 & Caroline O Cobb 5 & Kenneth D Ward 6 & Raed Behaleh 7 & Mehdi Fazlzadeh 8,9 Received: 8 August 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract There is mixed evidence surrounding the relationship between tobacco use and COVID-19 infection/progression. The current study investigates beliefs and tobacco use behaviors and COVID-19 infection among a sample of smokers and never-smokers. Data were collected using an online survey distributed through Telegram, a cloud-based social media networking application in Iran from April 1 to May 31, 2020. The study participants included never-smokers (n = 511), current (past-month) waterpipe smokers (n = 89), current cigarette smokers (n = 158), and ex-smokers (n = 172). Multinomial logistic regression was used to compare tobacco use groups with never- smokers on beliefs, controlling for potential confounders. The study participants (n = 944) was mostly male (64%), had > high school education (76%), and lived in an urban area (91%), with mean ± SD age of 35.3 ± 10.8. Key findings of this study are that compared with never-smokers: (1) cigarette smokers were less likely to believe that smoking cigarette can lead to spreading COVID-19; (2) waterpipe smokers were more likely to believe that smoking waterpipe at home was a safe practice, that waterpipe protects against COVID-19, and smoking waterpipe may lead to a more rapid recovery from COVID-19; (3) both waterpipe and cigarette smokers believed that using e-cigarettes in public places was a safe practice during the COVID-19 pandemic; and (4) more than half of the ex-smokers stopped smoking due to COVID-19 and most of them planned to continue abstaining from smoking after the pandemic. Our findings underscore the need to raise awareness about the unsupported claims of a lower hazard of using tobacco products or possible protective effects against COVID-19 and to promote cessation programs. Keywords COVID-19 . Cigarette . Waterpipe . E-cigarettes . Smoking . Harm perceptions . Iran

Introduction A growing debate about the potential link between COVID-19 severity and tobacco smoking is unfolding

(WHO 2020a). For example, a systematic review found lower smoking prevalence among patients hospitalized with COVID-19 in China compared with population smoking prevalence and hypothesized that nicotine—

Responsible Editor: Lotfi Aleya * Davoud Adham [email protected] * Mehdi Fazlzadeh [email protected]; [email protected] 1

Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA

2

Department of Internal Medicine, Pulmonary Division, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

3

Department of Kinesiology, College of Nursing and Health Innovation, University of Te