Change in prevalence of smoking during the first year of the COVID-19 pandemic among middle-aged and older adults in Canada: a cohort study of the Canadian Longitudinal Study on Aging

Objective: The primary objective was to evaluate the change in the prevalence of daily or occasional tobacco smoking during the first year of the COVID-19 pandemic and to assess if socioeconomic factors were associated with changes in smoking. The secondary objective was to evaluate the association of smoking with adherence to public health measures. Methods: In this prospective cohort study, using Canadian Longitudinal Study on Aging data (44 139 middle-aged and older-aged adults), the prevalence of smoking during the COVID-19 pandemic (2020) and prepandemic (2011-2018) was estimated using weighted generalised estimating equations. ORs and 95% CIs for the association between smoking and adherence to public health measures (a derived score) were estimated using multinomial logistic regression. Results: Time (during vs prepandemic) was a significant predictor of smoking (adjusted OR (aOR) 1.12; 95% CI 1.07, 1.17). The adjusted prevalence of smoking during the beginning of the pandemic was 11.2% (95% CI 10.1%, 12.4%), compared with the prepandemic prevalence of 10.1% (95% CI 9.1%, 11.2%), with p<0.001. Factors associated with an increase in smoking were male sex, being aged 55 to 74 years, residing in Ontario or British Columbia, immigrant background, belonging to a racialised group, higher income and being married/common-law relationship. Smoking was associated with increased odds of high adherence to public health measures (aOR 1.53; 95% CI 1.31, 1.78). Conclusion: Among middle-aged and older adults in Canada, there was a small increase in the adjusted prevalence of smoking early in the pandemic. Daily or occasional smoking was associated with greater adherence to public health measures.