Changes in the public health burden of tobacco use during the COVID-19 pandemic: the C4R Study

摘要/摘要 烟草产品的使用已被公认为是死亡和疾病的主要原因，但公众 新冠肺炎大流行背景下烟草的健康负担--已导致70多万人死亡 美国人和世界各地人口中根本改变的行为和健康-仍然不完全 明白了。新出现的证据表明，新冠肺炎大流行对个人和社会造成的破坏 导致了烟草使用模式的变化。新冠肺炎大流行早期的报道提供了不一致的 估计烟草使用与严重新冠肺炎风险之间的关系，一些研究表明 吸烟者的相对风险较低。这个应用程序将表征新冠肺炎大流行对 烟草使用模式以及COVID前烟草使用与COVID风险和严重程度之间的关联- 19人患病。 我们将在新冠肺炎研究(C4R)的合作队列中测试这些假设，a 对14个以人口为基础的多民族NIH资助队列的全国性研究，正在评估自我报告 使用标准化问卷在超过45,000名队列参与者中使用香烟和电子烟 广泛事先协调大流行前的烟草使用模式、社会人口统计、心理社会因素， 并有超过100万人年的合并症可用。C4R也在确定新冠肺炎 通过问卷调查病例，在子组中进行积极监测，并通过SARS-CoV-2血清学确认病例 和程序化的事件裁决。C4R已经收集了超过45,000份COVID问卷，超过 10,000个SARS-CoV-2血清学干血点，以及正在经历的1,000多个与CoVID相关的事件 裁决。 在目标1中，我们将确定和检查香烟和电子烟的状况、使用强度和 大流行期间(2020-22年)产品组合使用与大流行前烟草使用轨迹的比较 (1971-2019年)。这些变化将结合社会人口统计、心理社会因素、 合并症、COVID风险缓解行为(包括接种疫苗)和新冠肺炎病史。在目标2中， 我们将评估新冠肺炎的结果，包括SARS-CoV-2感染(PASC)的急性后遗症， 与前COVID非香烟烟草使用模式(烟斗、雪茄和电子烟)有关，以及 与使用香烟和从不使用烟草相比。 实现这些目标将支持有针对性的公共卫生干预措施，以促进吸烟 在烟草开始或复发的高危人群中避免和戒烟。它还将提供有效的 关于烟草使用是否会增加大流行时期不良健康后果的相对风险的信息 新冠肺炎或PASC，将适合于为公共卫生政策和法规提供信息。

Summary/Abstract Tobacco product use has been well established as a major cause of death and disease, yet the public health burden of tobacco in the context of the COVID-19 pandemic – which has already killed more than 700,000 Americans and radically altered behaviors and health in populations across the world – remains incompletely understood. Emerging evidence suggests that the personal and societal disruption of the COVID-19 pandemic has led to changes in tobacco use patterns. Reports from early in the COVID-19 pandemic provided inconsistent estimates of associations between tobacco use and risk of severe COVID-19, with some studies suggesting that smokers were at lower relative risk. This application will characterize the impact of the COVID-19 pandemic on tobacco use patterns and the association between pre-COVID tobacco use and the risk and severity of COVID- 19 illness. We will test these hypotheses in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), a nationwide study of 14 population-based multi-ethnic NIH funded cohorts, which is assessing self-reported cigarette and e-cigarette use using standardized questionnaires in over 45,000 cohort participants in whom extensive prior harmonization of pre-pandemic tobacco use patterns, socio-demographics, psychosocial factors, and comorbidities over >1 million person-years of follow-up are available. C4R is also ascertaining COVID-19 cases via questionnaires, with active surveillance in a subset, and validating cases via SARS-CoV-2 serology and protocolized events adjudication. C4R has already collected over 45,000 COVID questionnaires, over 10,000 dried blood spots for SARS-CoV-2 serology, and over 1,000 COVID-related events that are undergoing adjudication. In Aim 1, we will identify and examine changes in cigarette and e-cigarette status, intensity of use, and product mix use during the pandemic period (2020-22) compared to pre-pandemic tobacco use trajectories (1971-2019). These changes will be assessed in association with socio-demographics, psychosocial factors, comorbidities, COVID risk mitigation behavior (including vaccination), and history of COVID-19 illness. In Aim 2, we will assess whether COVID-19 outcomes, including post-acute sequelae of SARS-CoV-2 infection (PASC), are associated with pre-COVID non-cigarette tobacco use patterns (pipe, cigar, and e-cigarette), with comparison to cigarette use and never tobacco-use. Accomplishment of the Aims will support targeted public health interventions to promote smoking avoidance and cessation among groups at high risk of tobacco initiation or relapse. It will also provide valid information on whether tobacco use increases the relative risk of adverse pandemic-era health outcomes, severe COVID-19 or PASC, which will be suitable to inform public health policy and regulation.