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Factors associated with smoking behaviour changes during the COVID-19 pandemic in Japan: a 6-month follow-up study
  1. Takafumi Yamamoto1,
  2. Hazem Abbas2,
  3. Makiko Kanai3,
  4. Tetsuji Yokoyama1,
  5. Takahiro Tabuchi4
  1. 1 Department of Health Promotion, National Institute of Public Health, Wako, Japan
  2. 2 Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Sendai, Japan
  3. 3 Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
  4. 4 Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  1. Correspondence to Dr Takahiro Tabuchi, Epidemiological Statistics Department, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 541-8567, Japan; tabuchitak{at}


Background Smoking behaviour may have changed due to the COVID-19 pandemic, the April 2020 revised smoke-free policy and the high prevalence of heated tobacco product (HTP) use in Japan (10.9% in 2020). This study examined the association between these three events and smoking behaviour changes using 6-month follow-up data from before and during the pandemic.

Method Using longitudinal data from an internet survey conducted in February 2020 (baseline) and follow-up in August to September 2020, prevalence ratios (PR) and 95% confidence intervals (95% CIs) for smoking behaviour changes (increase and quit) were calculated using multivariable Poisson regression with adjustments for potential covariates including three event-related five factors: fear of COVID-19, living in a COVID-19 endemic area, workplace smoking rules, self-imposed smoking rules at home and type of tobacco use (cigarette only/HTP only/dual use). A smoker who reported an increase in smoking intensity in the last month was defined as an increase. A smoker who had stopped both cigarettes and HTPs at follow-up was defined as a quit.

Results We analysed 1810 tobacco users (1448 males (80%); mean age 50.8 years±13.2 SD). At baseline, 930 participants used cigarettes only, 293 HTPs only and 587 both. While 214 (11.8%) users increased smoking intensity, 259 (14.3%) quit both tobacco products. Those who feared COVID-19 were less likely to quit (PR=0.77, 95% CI 0.68 to 0.95), while living in a COVID-19 endemic area was not associated with either smoking behaviour change. Workplace smoking rules were not associated with either smoking behaviour change, but those with no home smoking ban were less likely to quit. Compared with cigarette-only users, HTP-only users were more likely to quit (PR=1.57, 95% CI 1.17 to 2.11), while dual users were more likely to increase smoking intensity (PR=1.35, 95% CI 1.01 to 1.79).

Conclusion During the pandemic, dual cigarette and HTP use increased smoking intensity, whereas HTP-only use was associated with quitting but fear of COVID-19 and not having a home smoking ban made it harder to quit.

  • COVID-19
  • Cessation
  • Public policy
  • Non-cigarette tobacco products

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (TT) upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (TT) upon reasonable request.

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  • TYa and TT contributed equally.

  • Contributors TYa and TT had full access to all of the study data and took responsibility for the integrity of the data and the accuracy of the data analysis. TYa and TT were involved in the study conception and design and the analysis and interpretation of data. Acquisition of data was performed by TT. TYa and TT drafted the manuscript. HA, MK and TYo contributed to the critical revision of the manuscript. HA contributed to the English language editing. All authors gave final approval and agreed to be accountable for all aspects of the work.

  • Funding This study was funded by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grants (grant numbers: 17H03589; 19K10671; 19K10446; 18H03107; 18H03062; 21H04856), the JSPS Grant-in-Aid for Young Scientists (grant number: 19K19439), Research Support Program to Apply the Wisdom of the University to Tackle COVID-19 Related Emergency Problems, University of Tsukuba and the Health Labour Sciences Research Grant (grant numbers: 22FA1002; 22FA2001; 20FA1005; 19FA1005; 19FG2001).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.