Negative Vaccine Attitudes and Intentions to Vaccinate Against Covid-19 in Relation to Smoking Status: A Population Survey of UK Adults.

Introduction: We examined differences in negative attitudes toward vaccines in general, and intentions to vaccinate against Covid-19 specifically, by smoking status in a large sample of adults in the UK.

Method: Data were from 29 148 adults participating in the Covid-19 Social Study in September-October 2020. Linear regression analyses examined associations between smoking status (current/former/never) and four types of general negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined associations between smoking status and uncertainty and unwillingness to be vaccinated for Covid-19. Covariates included sociodemographic characteristics and diagnosed health conditions.

Results: Relative to never and former smokers, current smokers reported significantly greater mistrust of vaccine benefit, were more worried about unforeseen future effects, had greater concerns about commercial profiteering, and had a stronger preference for natural immunity (Badjs 0.16-0.36, p < .001). Current smokers were more likely to be uncertain (27.6% vs. 22.7% of never smokers, RRadj 1.43 [95% confidence interval = 1.31-1.56]; vs. 19.3% of former smokers, RRadj 1.55 [1.41-1.73]) or unwilling (21.5% vs. 11.6% of never smokers, RRadj 2.12 [1.91-2.34]; vs. 14.7% of former smokers, RRadj 1.53 [1.37-1.71]) to receive a Covid-19 vaccine.

Conclusions: Current smokers hold more negative attitudes toward vaccines in general, and are more likely to be undecided or unwilling to vaccinate against Covid-19, compared with never and former smokers. With a disproportionately high number of smokers belonging to socially clustered and disadvantaged socioeconomic groups, lower vaccine uptake in this group could also exacerbate health inequalities.

Implications: These results suggest that without intervention, smokers will be less likely than nonsmokers to take up the offer of a Covid-19 vaccine when offered. Targeted policy action may be required to ensure that low uptake of Covid-19 vaccination programs does not compound health inequalities between smokers and nonsmokers.