Sustained decline in tobacco purchasing in Denmark during the COVID-19 pandemic

Background An estimated 8 million people die every year due to tobacco use. The COVID-19 pandemic has increased the health consequences of smoking, which is a leading risk factor for more severe COVID-19 symptoms, hospitalization, and death. The pandemic has also led to reductions in physical activity, increases in stress and declines in mental well-being, all factors commonly associated with triggering higher tobacco use. Methods Using a longitudinal data set of purchasing behavior from 2019-2020 among a national sample of the Danish population (n = 4042), we estimate changes in tobacco use during the COVID-19 pandemic. Our analysis compares tobacco purchases prior to the pandemic to purchases during the pandemic, at the individual level. We also examine effects within subgroups based on smoking behavior in 2019 prior to the pandemic. We estimate effects for smokers and non-smokers and, within smokers, for occasional smokers and regular smokers. Results We find large, sustained decreases in tobacco purchases during COVID-19. We estimate that weekly tobacco purchase rates decline by 24% and average quantities decline by 12% during the period spanning the onset of the pandemic in March 2020 through the end of the year. The declines are driven by regular smokers with little change in behavior among nonsmokers and increases in purchases among occasional smokers. Among regular smokers, purchase rates decline by about 30%, tobacco purchases decline by about 20% and quitting rates increase by about 10 percentage points. Conclusions Our results suggest that the COVID-19 pandemic could lead to sustained reductions in smoking. Plain language summary Being a smoker makes it more likely that a person will have severe COVID-19 symptoms, enter hospital, or die. This study assessed the amount of tobacco products purchased each week during 2019-2020 by a sample of the Danish population. The rate of people purchasing cigarettes weekly went down by 24% and the average quantities purchased decreased by 12% between March 2020 and the end of 2020. Regular smokers purchased about 30% less often and they purchased about 20% fewer cigarettes. Regular smokers were more likely to quit smoking than in the previous year. Our results suggest that the pandemic could lead to long term reductions in smoking.