Overview
The COVID-19 pandemic reshaped adolescent life, with school closures, social isolation, and heightened stress potentially altering smoking behaviors among youths. This article summarizes what a recent scoping review found about how the pandemic affected smoking initiation, cessation, and nicotine dependence in teenagers, and what it means for public health policy and future research.
What the evidence shows
Initiation and experimentation
Across diverse settings, studies reported mixed effects on smoking initiation. In some contexts, reduced peer contact and school-based social opportunities led to declines in new experimentation with cigarettes and, to some extent, vaping. Conversely, for some adolescents, pandemic-related stress, anxiety, and greater time spent online increased exposure to pro-smoking content and opportunities for experimentation, particularly among youths with existing risk factors. The net effect appears heavily contextual, reflecting differences in lockdown stringency, family environment, and access to products.
Cessation, dependence, and access to support
Evidence suggests disruptions to cessation efforts during lockdowns due to reduced in-person supports and school-based programs. At the same time, some youths leveraged telehealth cessation services or remote counseling with varying success. The pandemic’s stress and mental health burden were closely linked to nicotine dependence trajectories—some youths turned to nicotine as a coping mechanism, while others reduced use as routines changed with remote learning or reduced social opportunities. Access to cessation resources and the ability to obtain products remotely both emerged as key factors shaping these outcomes.
Product access and policy context
Changes in retail environments and policy enforcement during the pandemic influenced availability and purchasing patterns for tobacco and nicotine products. In some regions, online sales and delivery amplified access, while others implemented stricter age verification and marketing restrictions. These dynamics underscore the need to align tobacco-control efforts with broader pandemic responses, ensuring prevention and cessation supports keep pace with changing access landscapes.
Regional and demographic variations
Data gaps remain, especially from low- and middle-income countries. Where data exist, disparities by gender, race/ethnicity, urbanicity, and family smoking status emerged. Household stress levels, parental smoking behavior, and cultural norms around tobacco use shaped distinct adolescent smoking trajectories during the pandemic, indicating that one-size-fits-all strategies are unlikely to be effective.
Policy implications and practice
The findings highlight the need for resilient tobacco-control and youth health programs that endure during crises. Key actions include maintaining and expanding remote cessation resources, integrating mental health support with tobacco prevention, and ensuring consistent messaging about the risks of both conventional cigarettes and vaping. Programs should be adaptable to diverse adolescent populations and designed to monitor longer-term effects as pandemic conditions evolve.
Future research and limitations
Gaps remain in longitudinal data spanning multiple regions, particularly from lower-income settings. Future work should disentangle the effects of different nicotine products (e.g., cigarettes vs. e-cigarettes), measure pandemic-related stress with validated tools, and explore how vaccination campaigns, remote schooling, and economic pressures interact with adolescent smoking trajectories over time.
Conclusion
The COVID-19 pandemic produced nuanced, context-dependent shifts in adolescent smoking. While some youths reduced initiation due to less social interaction, others faced elevated risk from stress and online exposure. Strengthening remote prevention and cessation supports, and integrating mental health care, are essential to prevent lasting nicotine addiction as the pandemic evolves.
