COVID-19 a wake-up call for lifting the game on smoking cessation

19 October 2021

By Professor Chris Bullen

The COVID-19 pandemic provides a wake-up call for health workers lift their game and be more active in offering quit smoking support to people they encounter who may smoke tobacco.

While the relationship between smoking and the risk of contracting and surviving COVID-19 is not completely clear, the available evidence is sufficient to warrant increased efforts to promote smoking cessation. A recent systematic review of 73 articles with 863 313 COVID-19 patients in the meta-analysis found that smoking was significantly associated with a 19% increased risk for death in patients with COVID-19 (pooled relative risk = 1.19, 95% CI = 1.12–1.27).1 

As well as protecting against adverse COVID-19 outcomes, quitting can reduce the risk of smoking-related noncommunicable diseases that account for a larger proportion of deaths than COVID-19.2

Despite these risks, in a recent online survey of people who smoke in New Zealand, Australia and the United Kingdom, around half (51%) of the respondents reported that they had heard little or nothing about COVID-19 risks for smokers prior to participating in the survey.3

New Zealanders were very receptive to quitting messages that emphasise the risks to their health and the threat to the functioning of the health system; 42% said they intended to quit smoking immediately or in the next two weeks. And 44% of respondents accessed additional information about their smoking-related COVID-19 risk after taking part in the survey.

Interestingly, messages with the strongest fear appeal had among the largest effects on quit intentions but the weakest effect on information seeking, whereas the message focused on financial outcomes had the strongest effect on information seeking but among the weakest effects on quit intentions.

These results should give confidence to health professionals to be proactive in asking about smoking, giving brief advice to quit smoking to people who smoke (linking the advice to the potential for health benefits) and offering the evidence-based support outlined in the recently updated Ministry of Health’s Guidelines for Helping People to Stop Smoking.4


  1. Hou, H., Li, Y., Zhang, P., Wu, J., Shi, L., Xu, J., Diao, J., Wang,Y., Yang, H. (2021) Smoking Is Independently Associated With an Increased Risk for COVID-19 Mortality: A Systematic Review and Meta-analysis Based on Adjusted Effect Estimates, Nicotine & Tobacco Research, 23 (11):1947–1951,
  2. Hefler, M., Gartner, CE. (2020) The tobacco industry in the time of COVID-19: time to shut it down? Tob Control. 29(3):245–246.
  3. Pettigrew, S., Jun, M., Roberts, I., Nallaiah, K., Bullen, C., & Rodgers, A. (2021). The Potential Effectiveness of COVID-Related Smoking Cessation Messages in Three Countries. Nicotine & Tobacco Research 23(7), 1254–1258.
  4. Ministry of Health (2021). The New Zealand Guidelines for Helping People to Stop Smoking Update. Wellington: Ministry of Health.