INTRODUCTION: We used a longitudinal cohort of U.S. adults who were current or former smokers to explore how three participant-reported factors - general stress, COVID-19 distress, and perceived risk of complications from COVID-19 related to smoking - were associated with changes in smoking status. METHODS: Smoking status was assessed at three time points. Timepoint 1 status was assessed at a prior study completion (2018-2020). Timepoint 2 (start of the pandemic) and Timepoint 3 (early phase of the pandemic) statuses were assessed using an additional survey in 2020. After classifying participants into eight groups per these time points, we compared the means of participant-reported factors and used a linear regression model to adjust for covariates. RESULTS: Participants (n=392) were mostly female (73.9%) and non-Hispanic White (70.1%). Between Timepoints 2 and 3, abstinence rates decreased by 11%, and 40% of participants reported a smoking status change. Among those reporting a change and the highest general stress levels, newly abstinent participants had higher perceived risk of complications from COVID-19 related to smoking than those who relapsed during pandemic (mean (standard deviation): 14.2 (3.3) vs. 12.6 (3.8)). Compared to participants who sustained smoking, those who sustained abstinence, on average, scored 1.94 less on the general stress scale (betaeta Coefficient (beta): -1.94, p-value < 0.01) and 1.37 less on the perceived risk of complications from COVID-19 related to smoking scale (beta: -1.37, p-value 0.02). CONCLUSIONS: Decreased abstinence rates are concerning. Patterns of reported factors were as expected for individuals who sustained their smoking behavior but not for those who changed. IMPLICATIONS: We observed an increase in smoking rates during the COVID-19 pandemic. In exploring how combinations of general stress levels, COVID-19 distress levels, and perceived risk of complications from COVID-19 related to smoking were associated with changes in smoking, we observed expected patterns of these factors among individuals who sustained abstinence or smoking. Among individuals who changed smoking status and reported high stress levels, those who reported a higher perceived risk of complications from COVID-19 related to smoking abstained from smoking. In contrast, those who reported a lower perceived risk of complications from COVID-19 related to smoking, started smoking. An intersectional perspective may be needed to understand smokers' pandemic-related behavior changes.

In the early weeks of the COVID-19 pandemic, the large number of cases of severe respiratory distress placed a significant burden on US healthcare systems. In Massachusetts, predictive modeling indicated that up to 15,000 hospital beds would be required to handle the case surge (prior to the COVID-19 pandemic, Massachusetts hospitals had a total of 11,000 licensed beds). This modeling suggested there would be a 4,000-bed shortage during the peak of hospitalizations for COVID-19, which was expected to occur within the first few weeks of April. Thus, mitigation strategies were developed to increase healthcare capacity. One of Massachusetts’ strategies entailed the development and utilization of field hospitals. On April 2, 2020, it was announced that a convention center in Worcester, MA, would be the location of the state’s first field hospital (FH). Through the collaboration of the US Army National Guard company based in Worcester and UMass Memorial Medical Center (UMMMC), the FH was quickly established. It was determined that on-site pharmacy services would be imperative to ensure that FH patients received optimal care.