Impact of the COVID-19 pandemic on tobacco product consumption and behavioral patterns from a low-middle income country perspective: A qualitative study.

Introduction: Previous studies investigating socioeconomic status and tobacco consumption during the COVID-19 pandemic were survey-based. To extend knowledge beyond prevalence rates and trends of tobacco consumption, qualitative research is needed to identify individual's experiences. There is a critical gap within this context, particularly in low-middle income countries. The aim of the study was to perform a qualitative analysis on consumption patterns of tobacco users from a low-middle income country during the COVID-19 pandemic, and to identify factors influencing motivation to quit tobacco products during the pandemic and the perceptions of self-risk for complications of tobacco consumption and COVID-19.

Methods: A qualitative study was conducted in São Paulo, Brazil in September 2020. We used a focus group with semi-structured interviews. Participants were invited to answer questions about behavioral and consumption patterns of tobacco products during early stages of COVID-19 pandemic. Two investigators independently performed triangulation of content of the transcripts. Data were analyzed using inductive content analysis.

Results: Eighteen participants were evaluated (66.7% males) with mean age 34.1 ± 14.9 years. Many participants presented high levels (33.3%) of nicotine dependence. Thematic analysis of participants' narratives resulted in two themes: Theme 1: Behavioral and psychological factors impacting consumption; and Theme 2: Consumption patterns, dependence, and information. Open-coding process resulted on four codes: 1) Behavioral and lifestyle changes; 2) Psychological and motivational factors; 3) Consumption patterns and dependence; and 4) Information exposure and awareness. Nine categories were generated from the codes.

Conclusions: Behavioral and consumption patterns varied significantly in tobacco users in Brazil during the early stages of the COVID-19 pandemic, ranging from increases to no changes. Individuals consuming tobacco products showed awareness about the harmful effects of smoking and COVID-19 complications.