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% <high school education, 56.5% <=$25000 annual income) enrolled in a smoking cessation trial, from 3 FQHCs in rural Georgia (November 2020 to December 2022). Multivariable multinomial regression examined home smoking environments (i.e. household members who smoke, household smoking rules) and changes in stress in relation to: 1) smoking increases/decreases in general and in the home, and 2) quit attempts since pre-pandemic. 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.