Changes in Smoking Behavior, Stress, and Sleep Duration Among Israeli Hospital Workers During the COVID-19 Pandemic: A Cross-sectional Study

Introduction Being on the COVID-19 frontline could negatively impact healthcare workers mental health. Aims and Methods We examined smoking behavior changes and the association with changes in stress levels and sleeping patterns among hospital workers during the pandemic. An online survey was conducted among employees of a large tertiary medical center in Israel. Data collected included sociodemographic characteristics, smoking status, changes in smoking behavior (for smokers only), stress levels, and sleeping duration during the pandemic, perceptions of risk for COVID-19 infection and disease severity, presence of a chronic illness, COVID-19 exposure and infection status, and involvement in treating COVID-19 patients. Multinominal logistic regression modeling assessed the effects of covariates on smoking behavior change. Results Overall, 920 healthcare workers participated. More than half (59%) reported an increase in stress and 28% reported changes in sleep duration. Thirty-five percent of current smokers (n = 132), reported smoking more. Increased stress was associated with an increase in smoking (odds ratio [OR] = 3.45, 95% confidence interval [CI] 1.2-9.4, p = .016), and an increase in sleeping hours was significantly associated with a decrease in smoking (OR = 6.42, 95% CI 1.2-32, p = .02). Among smokers who reported perceived levels of stress to be the same or slightly higher than prepandemic, a strong inverse association was observed between sleep and smoking. Conclusions The mental health consequences of the pandemic, specifically for health workers, could lead to negative changes in smoking behaviors. Together with offering stress-management skills and coping strategies, mental health support should target smoking behaviors and sleep disturbances. Implications A high proportion of healthcare employees working in a large tertiary medical center in Israel reported increased stress levels during the COVID-19 pandemic. Among smokers, increased stress levels were associated with increased smoking, suggesting that smoking may be a coping mechanism for COVID-19-related stress. Offering stress-management skills and coping strategies can mitigate the negative impact on health workers' smoking behavior, and reduce stress-related increases in smoking behavior.