Interview Highlights: Tobacco Control, Social Support, and Coping During the Pandemic With Daniel Giovenco

By: Makena Binker Cosen (CC ‘21)

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Cover illustration by: Vanessa Vasquez (SEAS '23)

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​Daniel Giovenco, PhD, MPH, is an Assistant Professor at Columbia University Mailman School of Public Health. He uses geographical information systems, field data collection, and survey data to identify social and environmental determinants of tobacco use disparities.

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The following is a heavily condensed version of the full interview. If you're interested, read more here.


What do we know about the relationship between tobacco use and a person’s risk of getting COVID-19 and developing related health outcomes?

The health consequences that smoking causes, such as cancer, heart disease, and COPD, are known risk factors for poor COVID-19 outcomes and increased mortality. 

Research on the relationship between smoking and COVID-19, however, is mixed. While many studies have documented worse outcomes among patients who smoke, others have found that the rate of smoking among COVID patients is much lower than what one would expect.

Poor data collection may be responsible for mixed results: we don’t know how COVID patients are being asked about their smoking status or if patient responses are fully accurate. Could nicotine truly be playing a protective role because of its interactions with the inflammatory processor? That’s something basic scientists could investigate.


What inspired your COVID-related research?

I got to a point where the precise relationship between smoking and COVID seemed less important than finding out how people’s smoking behaviors shift during the pandemic. The fact is that the measures that have been put into place to prevent COVID-19 from spreading, like stay-at-home orders, social distancing, and store closures, are affecting people’s substance use behaviors, including smoking. 

I wanted to better understand the behaviors of people who smoke and vape and may be addicted to those products during this period of high stress and unprecedented change, with the goal of identifying ways to better support their health and well-being. ​

Could you please describe your current research project?

​We conducted in-depth semi-structured interviews with people from all over the country who smoke or vape. The “semi” in “semi-structured interviews” means that we planned questions ahead of time, but we also left room for conversations to flow naturally. 

We’ve had fifty hour-long interviews where people talked to us about all the ways the pandemic has impacted their lives in general and altered their substance use behaviors. Right now, we are transcribing the audio of the interviews so we can start analyzing the data to look for consistent themes and unexpected findings. ​​ 

What was the recruitment process for the interviews like?

​We used Facebook and Instagram advertising to recruit participants. We displayed advertisements that said, “Help Columbia University researchers understand health behaviors during COVID-19” to thousands of people across the country. 

If they clicked on the ad, it took them to a screener survey that assessed their eligibility to participate. To be eligible, they had to be over 18 years old and currently smoke or use a vaping product.

We got a really diverse set of participants in terms of income level, geography, smoking behaviors, and underlying conditions. We used the screener survey results to make sure we had representation from certain groups. For example, there weren’t too many people over 70 years old completing the survey, but there were some, so we could reach out to underrepresented individuals to make sure that their voices were heard, too. 


Based on your interviews, how has the pandemic influenced tobacco use behavior?

Almost every person in our sample reported that their smoking or vaping behaviors changed in some way during the lockdown period. While some respondents reduced their use, increases in smoking or vaping was much more common. They shared that they felt like they needed to do this to relieve stress, boredom, and feelings of uncertainty.

Participants acknowledged that smoking or vaping could put them at increased risk for COVID-19 or intensify their addiction beyond the pandemic. However, when we asked about their intentions to quit, we received a resounding “no, now is not the time.”

People right now aren’t thinking about their smoking behaviors. We spoke to people who are in really, really dire circumstances — people who lost their jobs and are financially struggling; whose family members are sick or died. With the amount of stress, exhaustion, and sadness they are processing, it’s just not a priority. Many of them said, “I would love to quit. I know I should. I just can’t even think about that now. Smoking allows me to deal with all of the other stuff that is my priority right now.” 

As a public health professional, all of this has made me wonder what the next steps are when people have so many competing priorities other than the one we’re trying to intervene on.


On a more personal level, what has this research experience been like for you?

It felt nice to directly connect with people, especially during a pandemic. The people we talked to said they also enjoyed sharing their experiences about the ways COVID-19 has impacted their lives. They appreciated that people were looking into ways to better support the health and well-being of people who have various addictions. 

With qualitative research, you’re not just pulling data and spitting it out; you form relationships with people. Since I usually conduct quantitative studies, as a researcher, this experience has made me feel more human than any other project.


Has the pandemic affected people who smoke and those who vape differently?

Yes, we noticed a significant divergence in access to cigarettes and vaping products. 
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A lot of people are having trouble finding basic necessities, but cigarettes are everywhere. A very illustrative quote from the interviews was something like, “no toilet paper, but plenty of Camel cigarettes!” Most essential businesses that have stayed open, like gas stations, drug stores, and grocery stores, sell cigarettes. Thus, it’s just as easy to get them now as it was before the pandemic started.

However, a lot of retailers that sell vaping products, like vape shops, were considered non-essential businesses in many places and shut down. A lot of people who vape said they have been ordering their products online now. 

Sometimes, they have to wait weeks to get them delivered. If you’re addicted to something, not knowing when the next supply is going to come can be a real source of stress. ​

Concerningly, some vapers reported that they have gone back to smoking cigarettes because they’re just easier to get. We know that cigarettes are generally more harmful than vaping, although vaping certainly isn’t without risk. 


Do you have any recommendations for people using substances to cope?

I now have a much better understanding of why people continue to use any of these products and I empathize with them. That said, my “public health” answer is that this is probably the best time to quit considering the risks of COVID, although I acknowledge that it’s probably the most difficult time to quit. 

​When we asked people what they would need to quit successfully, they always mentioned social support, which is very limited right now. But even though the world seems like it has stopped, there are still quitting resources available. For example, state Quitlines are still open, offering access to free nicotine replacement therapies. There are also virtual support groups and a lot of other great tools out there. It’s difficult, but it’s still possible to quit.

Where should public health professionals working towards tobacco cessation and prevention be focusing their efforts moving forward?

Initiation has been slowing even before the pandemic started and my guess is that it will continue to decrease. Even so, there are people who we need to support more strongly than ever. Smoking has lost some attention among the general public because for many, it is an “invisible” problem: in a lot of people’s circles, they don’t know anyone who smokes. Although the national smoking rate is around 14%, among populations that face a lot of social and economic disadvantages, rates are just as high as they were decades ago. The smoking rate among people with mental health disorders, for example, is around 30-40%.

This pandemic has exposed and magnified the major cracks in our society, particularly social injustices. A lot of people said they would need a job, financial stability, and social support to quit successfully: “once I’m at that stable place, I can do anything.” Fixing those systemic issues would hopefully lead to improvements in substance use and addiction. In some ways, disparities in tobacco use today is an outward symptom of a much larger underlying problem.