Influence of the home smoking environment and stress on smoking behaviors during the COVID-19 pandemic among patients of federally qualified health centers in rural Georgia.

Introduction: The COVID-19 pandemic caused major stress, as well as changes to home and work environments, with the potential to alter smoking-related behaviors. This study examined determinants of smoking-related behaviors among patients of federally qualified health centers (FQHCs) in Georgia.

Methods: We analyzed survey data from 353 patients (mean age=50 years, 62.9% women, 54.4% Black/African American, 27.8%
Results: Most study participants (85.6%) smoked daily, and 41.6% had smoke-free homes. Compared to pre-pandemic, 36.3% reported increased stress, 28.8% increased smoking, 18.8% increased in-home smoking, and 55.4% quit attempts. Regression models showed more household members who smoke (AOR=1.56; 95% CI: 1.02-2.39) and greater stress (AOR=5.52; 95% CI: 2.74-11.12) were associated with increased smoking (vs no change) since the pandemic began. Non-daily (vs daily) smoking (OR=4.79; 95% CI: 1.71-13.46) was associated with decreased smoking (vs no change). Allowing smoking in the home and greater stress were associated with both increased and decreased in-home smoking (vs no change). We found no associations with quit attempts.

Conclusions: Home environments, specifically home smoking restrictions, as well as stress, may be important intervention targets during societal stressors.