Changing pattern of tobacco use and effect of behavioral interventions on tobacco dependence during COVID-19 – Mixed-method study

Background: Tobacco is a risk factor for noncommunicable diseases, and its users are at an increased risk for developing severe illness if affected by COVID-19. Aims and Objectives: This study was conducted to report tobacco usage patterns and experiences during COVID-19 and assess changes in tobacco dependence following behavioral interventions. Methodology: A mixed-method study was conducted, and the details of individuals who visited the tobacco cessation clinic, psychiatric ward, and department of pulmonary medicine from September 2019 to February 2020 were obtained from the hospital records. These individuals were contacted by telephone and were requested to fill out the Google Forms. Results: Following the initial analysis of nicotine dependence among the participants, 12 individuals were shortlisted for the in-depth interview on tobacco use experience during COVID-19. After the qualitative component was over, the participants were divided into two groups based on the ratio of 1:1. A behavioral intervention using online group sessions (using WhatsApp and Google Meet) along with telephonic counseling was administered to group 2 while group 1 received only telephonic counseling. At the end of 1 month, the participants were again followed up. Analysis: Only one participant reported an increase in the frequency of habit during COVID-19 and the reason was lack of work engagement. Most of the participants were at home during the pandemic, and some of them reported not having felt the need to smoke at home, as there were other modes of spending time at home. A statistically significant difference was found in the comparison of the before and after Fagerstorm nicotine dependence score for smokers in group 1 participants. However, a statistically insignificant difference was found in the comparison of the Fagerstorm nicotine dependence score for smokeless tobacco (ST) postintervention in the group 1 participant. The group 2 participants showed a statistically significant difference in the nicotine dependence scores for both smokers and ST after the intervention.