Tobacco Use and Behavioural Changes During the COVID-19 Pandemic: A Cross-sectional Study Among Adults in Chennai

Background: The COVID-19 pandemic significantly influenced tobacco use, presenting both challenges and opportunities for behavioural change. Understanding these shifts is crucial for targeted public health strategies. Objectives: This study aimed to evaluate changes in tobacco use among adults in Chennai during the COVID-19 pandemic, identify high-risk subgroups, and assess associations between smoking behaviour and self-perceived physical and psychological health. Methods: A cross-sectional survey was conducted among 500 adults (18–65 years) using structured questionnaires. Data included demographics, tobacco consumption before and after the pandemic, COVID-19 infection severity, and self-rated health. Statistical tests and logistic regression were applied. Results: Of the 500 participants, 54% reduced smoking, 32% quit, and 12% increased use. Average daily cigarettes decreased from 15.2 to 9.1 (p<0.001). Rural residents reported greater reduction than urban (p<0.05). Quitting/reducing smoking was associated with improved self-rated health and lower odds of hospitalisation (OR=0.42, 95% CI 0.25–0.72) and ICU admission (OR=0.35, 95% CI 0.19–0.65). Conclusion: The pandemic served as a catalyst for smoking reduction and cessation, with disparities observed among men, long-term smokers, and urban residents. Integrating cessation support into digital platforms and mental health services could consolidate public health gains.