The impact of the COVID-19 pandemic on smoking in adolescents: a scoping review

Background

The COVID-19 pandemic and associated policies have influenced adolescent smoking behaviours, with potential impacts on smoking initiation, cessation, and addiction. This scoping review aims to summarise existing evidence on how the pandemic affected adolescent smoking behaviour across various contexts.

Methods

A systematic search was conducted in September 2023 across three databases—Embase, APA PsycInfo, and Medline—using terms related to adolescents, COVID-19 exposure, and smoking behaviours. Studies were included if they focused on adolescents aged 12–21, examined smoking-related outcomes during or after the pandemic, and were published from 2019 onwards. Study quality was not assessed in this research. The search identified 18 studies, which were independently screened by two reviewers, with conflicts resolved by a third reviewer. Thematic analysis was used to categorise the studies.

Results

Of the 18 studies, most were retrospective and focused on high-income countries, including the United States, Israel, and the Netherlands. Trends in smoking behaviour varied, with some studies reporting increased smoking during the pandemic, particularly in regions like the United States and Netherlands; others observed reductions in smoking, such as in France and Spain; and others observed mixed results, such as South Korea. The impact of mental health was significant, with increased anxiety and depression linked to higher smoking rates, especially in the United States and Israel. Several known risk factors, such as peer influence, parental smoking habits, and family dynamics, also played a role. Reduced peer interactions and time spent with family were associated with reductions in smoking behaviour. In contrast, adverse family dynamics or the presence of smoking family members contributed to higher smoking rates. Further, the impact of COVID-19 on these factors varied: peer influence decreased due to social distancing measures, while mental health issues such as increased anxiety and depression were associated with higher smoking rates.

Conclusion

This review highlights the complex and heterogeneous impacts of COVID-19 on adolescent smoking behaviours. Mental health, social interactions, and family dynamics were key factors influencing smoking patterns. These findings can inform the development of targeted smoking cessation and prevention strategies for adolescents, particularly in the context of future public health crises.