January 20, 2021

The latest research suggests that people who smoke or vape may be at higher risk of contracting COVID-19 or experiencing poorer health outcomes. This places a greater urgency on public health organizations to develop strategies that communicate these risks. A recent study that includes findings from experts at UNC-Chapel Hill suggests that messages linking COVID-19 to smoking may be effective in discouraging cigarette use.

Dr. Anna Grummon

Dr. Anna Grummon

“Before the pandemic, we knew from decades of research that smoking can cause many health harms. Evidence is growing that vaping might also cause harm,” said Anna H. Grummon, PhD, Harvard Bell Fellow and 2019 doctoral alumna in health behavior. “Since the pandemic, some have suggested that smoking and vaping may worsen the harms caused by COVID-19, though this relationship is still being researched. Our study was the first to investigate whether messages linking smoking and vaping to COVID-19 harms would discourage people from wanting to smoke and vape.”

The study, published in Tobacco Control, features the work of researchers from the UNC Gillings School of Global Public Health, the Harvard T.H. Chan School of Public Health, the UNC Hussman School of Journalism and Media and the UNC Lineberger Comprehensive Cancer Center.

Dr. Marissa Hall

Dr. Marissa Hall

Dr. Seth Noar

Dr. Seth Noar

Dr. Kurt Ribisl

Dr. Kurt Ribisl

Dr. Noel Brewer

Dr. Noel Brewer

Grummon led the study in collaboration with Marissa Hall, PhD, assistant professor of health behavior; master of public health students Chloe Mitchell and Marlyn Pulido; Jennifer Mendel Sheldon, project director at UNC Lineberger; Seth Noar, PhD, professor at the Hussman School; Kurt Ribisl, PhD, Jo Anne Earp Distinguished Professor and department chair of health behavior; and Noel Brewer, PhD, professor of health behavior.

Example tweets from the study display messages about COVID-19, smoking and vaping.

Example tweets from the study display messages about COVID-19, smoking and vaping.

Participants in the study were shown messages about smoking and vaping formatted as a tweet from the Centers for Disease Control and Prevention. These tweets were randomly assigned to focus on different topics. Messages talked about the general harms of smoking or vaping (immune function, heart damage and lung damage), the harms of smoking or vaping related to COVID-19, or a neutral message that served as a control. The researchers also varied other aspects of the message, such as mentioning a single health harm or three health harms.

The study measured perceived message effectiveness – the extent to which participants thought the message discouraged them from smoking or vaping. It also measured other reactions, including the negative feelings caused by the message, how much a participant thought about health problems and whether beliefs about smoking or vaping’s harm changed.

Overall, messages linked to smoking and COVID-19 were effective at discouraging use of cigarettes, as were messages that included traditional smoking harms. Messages about both traditional and COVID-19 harms were not more effective than messages about COVID-19 harms alone. Similarly, messages that discussed all three traditional health harms were as effective as messages about just one of these harms. Such results suggest that simplicity in communication may produce the best outcome.

In contrast, messages that included harms related to COVID-19 and vaping were not as effective in discouraging e-cigarette use. Instead, participants were more effectively discouraged by the link between vaping and traditional harms.

“Our results indicate that public health organizations have several promising options for messages to discourage tobacco use,” said Grummon. “To discourage smoking, agencies can consider messages linking smoking to either COVID-19 or to traditional health harms like lung damage. For vaping, messages focused on traditional harms may work best.“

As the world continues to navigate the effects of the pandemic, experts will need to continue investigations into the impact that smoking can have on susceptibility to COVID-19. The study, however, shows encouraging signs for public health communicators that messages about smoking’s harms related to COVID-19 could be beneficial in the fight against tobacco use.


Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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