@article {Jacksone111, author = {Sarah E Jackson and Jamie Brown and Lion Shahab and Andrew Steptoe and Daisy Fancourt}, title = {COVID-19, smoking and inequalities: a study of 53 002 adults in the UK}, volume = {30}, number = {e2}, pages = {e111--e121}, year = {2021}, doi = {10.1136/tobaccocontrol-2020-055933}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background This study aimed to examine associations between smoking and COVID-19 relevant outcomes, taking into account the influence of inequalities and adjusting for potential confounding variables.Methods Cross-sectional data were used from an online study of adults in the UK (n=53 002). Main outcome measures were confirmed and suspected COVID-19, worry about catching or becoming seriously ill from COVID-19 and adherence to protective behaviours. Covariates included age, sex, ethnicity, education (post-16 qualifications: yes/no), key worker status and comorbid health conditions.Results Compared with never smokers (0.26\% (95\% CI 0.21\% to 0.33\%)), prevalence of confirmed COVID-19 was higher among current (0.56\% (0.41\% to 0.75\%)) but not ex-smokers (0.19\% (0.13\% to 0.28\%)). Associations were similar before (current: OR=2.14 (1.49{\textendash}3.08); ex-smokers: OR=0.73 (0.47{\textendash}1.14)) and after (current: OR=1.79 (1.22{\textendash}2.62); ex-smokers: OR=0.85 (0.54{\textendash}1.33)) adjustment. For current smokers, this was moderated by socio-economic position, with higher rates only seen in those without post-16 qualifications (OR=3.53 (2.04{\textendash}6.10)). After including suspected cases, prevalence was higher among current smokers (11.2\% (10.6\% to 11.9\%), OR=1.11 (1.03{\textendash}1.20)) and ex-smokers (10.9\% (10.4\% to 11.5\%), OR=1.07 (1.01{\textendash}1.15)) than never smokers (10.2\% (9.9\% to 10.6\%)), but remained higher only among ex-smokers after adjustment (OR=1.21 (1.13{\textendash}1.29)). Current and ex-smokers had higher odds than never smokers of reporting significant stress about becoming seriously ill from COVID-19 (current: OR=1.34 (1.27{\textendash}1.43); ex-smokers: OR=1.22 (1.16{\textendash}1.28)). Adherence to recommendations to prevent spread of COVID-19 was high (96.3\% (96.1\% to 96.4\%)), but lower among current than never smokers (OR=0.70 (0.62{\textendash}0.78)).Conclusions In a population sample, current smoking was independently associated with self-reported confirmed COVID-19 infection. There were socio-economic disparities, with the association only apparent among those without post-16 qualifications. Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19.No data are available. Anonymous data will be made available following the end of the UK pandemic.}, issn = {0964-4563}, URL = {https://tobaccocontrol.bmj.com/content/30/e2/e111}, eprint = {https://tobaccocontrol.bmj.com/content/30/e2/e111.full.pdf}, journal = {Tobacco Control} }