Fear of COVID-19 among nonsmokers and smokers/former smokers: Implications for health promotion practice





COVID-19, smoking, fear, anxiety, health promotions


Introduction: Fear of COVID-19 may differ for individuals with compromised health and those with unhealthy behaviors, placing them at greater risk. Based on previous analysis of academic medical center faculty and staff, the authors predicted that workers who were smokers/previous smokers would express the greater fear of COVID-19 relative to nonsmokers.

Methods: The present study used the Fear of COVID-19 Scale to assess fear among nonsmokers (n = 1,489) and smokers/previous smokers (n = 272) from a larger population of academic medical center members (N = 1,761). This study assessed nonsmokers’ and smokers/previous smokers’ demographic and background variables on Fear of COVID-19 scores.

Results: In this academic community, smokers/previous smokers had higher fear of COVID-19 scores than did nonsmokers (p < 0.05). Smokers/previous smokers differed from nonsmokers on three Fear of COVID-19 scale items (most afraid of COVID-19, fear of losing life, and physiological fear of COVID-19).

Discussion/conclusions: These results provide a better understanding of how fear of COVID-19 can differ based on one’s smoking status. These findings inform public health smoking cessation efforts aimed at reducing morbidity and mortality, both in response and secondary to COVID-19 exposure.

Author Biographies

Blake T. Hilton, PsyD

Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Brandt J. Wiskur, PhD

Department of Academic Affairs and Faculty Development, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Michael W. Brand, PhD

Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Julio I. Rojas, PhD

Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Raina D. Leckie, LCSW

Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Maria Trapp, PhD

Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Katrin Gaardbo Kuhn, PhD

Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma


Coronavirus Resource Center: COVID-19 Dashboard. Center for Systems Science and Engineering, Johns Hopkins University. Available at https://coronavirus.jhu.edu/map.html. Accessed September 12, 2022.

Brake SJ, Barnsley K, Lu W, et al.: Smoking upregulates angiotensin-converting enzyme-2 receptor: A potential adhesion site for novel coronavirus SARS-CoV-2 (COVID-19). JCM. 2020; 9: 841. DOI: 10.3390/jcm9030841.

Tetik BK, Tekinemre IG, Tas S: The effect of the COVID-19 pandemic on smoking cessation success (2020). J Comm Health. 2020; 8: 1-5. DOI: 10.1007/s10900-020-00880-2.

Berlin I, Thomas D, Le Gao AL, et al.: COVID-19 and smoking. Nicotine Tob Res. 2020; 22: 1650-1652. DOI: 10.1093/ntr/ntaa059.

Vardavas C, Nikitara L: COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020; 18: 20-24. DOI: 10.18332/tid/119324.

Patanavanich R, Glantz SA: Smoking is associated with COVID- 19 progression: A meta-analysis. Nicotine Tob Res. 2020; 22: 653-656. DOI: 10.1093/ntr/ntaa082.

Reddy RK, Charles WN, Sklavounos A, et al.: The effect of smoking on COVID-19 severity: A systematic review and meta-analysis. J Med Virol. 2021; 93: 1045-1056. DOI: 10.1002/jmv.26389.

Zhao Q, Meng M, Kumar R, et al.: The impact of COPD and smoking history in the severity of COVID-19: A systemic review and meta-analysis. J Med Virol. 2020; 92: 1915-1921. DOI: 10.1002/jmv.25889.

Alqahtani JS, Oyelade T, Aldhahir AM, et al.: Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: A rapid systematic review and meta-analysis. PLoS One. 2020; 15: E0233147. DOI: 10.1371/journal.pone.0233147.

Farsalinos K, Barbounia R, Poulas K, et al.: Current smoking, former smoking, and adverse outcome aiming hospitalized COVID-19 patients: A systematic review and meta-analysis. Ther Adv Chronic Dis. 2020; 11: 204062232093576-14. DOI: 10.1177/2040622320935765.

Xia Y, Jin R, Zhao J, et al.: Risk of COVID-19 for patients with cancer. Lancet Oncol. 2020; 21: E180. DOI: 10.1016/S1470-2045(20)30150-9.

Xiang Y, Yang Y, Li W, et al.: Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatr. 2020; 7: 228-229. DOI: 10.1016/s2215-0366(20)30046-8.

Liu TB, Chen XY, Miao GD, et al.: Recommendations on diagnostic criteria and prevention of SARS-related mental disorders. J Clin Psychol Med. 2003; 13: 188-191.

Stein MB: COVID-19: Psychiatric illness. UpToDate. 2021. Updated January 28, 2021. Available at https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-psychiatric-illness. Accessed March 22, 2021.

Lee SA: Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Stud. 2020; 44: 393-401. DOI: 10.1080/07481187.2020.1748481.

Balaratnasingam S, Janca A: Mass hysteria revisited. Curr Opin Psychiatry. 2006; 19: 171-174. DOI: 10.1097/01.yco.0000214343.59872.7a.

Harper CA, Satchell LP, Fido D, et al.: Functional fear predicts public health compliance in the COVID-19 pandemic. Int J Ment Health Addict. 2021; 19(5): 1875-1888.

Winter T, Riordan BC, Pakpour AH, et al.: Evaluation of the English version of the fear of COVID-19 scale and its relationship with behavior change and political beliefs. Int J Ment Health Addict. 2020; 1-11. DOI: 10.1007/s11469-020-00342-9.

Ahorsu DK, Lin C, Imani V, et al.: The fear of COVID-19 scale: Development and initial validation. Int J Ment Health Addict. 2020; 1-9. DOI: 10.1007/s11469-020-00270-8.

Reznik A, Gritsenko V, Konstantinov V, et al.: COVID-19 fear in Eastern Europe: Validation of the fear of COVID-19 scale. Int J Ment Health Addict. 2020; 1-6. DOI: 10.1007/s11469-020-00283-3.

Brand MB, Wiskur B, Rojas JI: Assessing fear of COVID-19 at an academic medical center. J Emerg Manag. 2021; 18: 91-98. DOI: 10.5055/jem.2020.0000.

United Health Foundation: America’s health rankings analysis of CDC. Behavioral Risk Factor Surveillance System. Available at AmericasHealthRankings.org. Accessed 2022.

Miller WR, Rollnick S: Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford, 2013.

Prochaska JO, Redding CA, Evers KE: The Transtheoretical Model and Stages of Change. 2nd ed. Hoboken, NJ: Jossey-Bass, 1997.

Prochaska JO, DiClemente CC: Toward a comprehensive model of change. In Miller WR, Heather N (eds.): Treating Addictive Behaviors: Process of Change. New York: Plenum, 1986: 3-24.

Caponnetto P, Inguscio L, Saitta C, et al.: Smoking behavior and psychological dynamics during COVID-19 social distancing and stay-at-home policies: A survey. Health Psychol Res. 8: 68-73. DOI: 10.4081/hpr.2020.9124.

Ajzen I, Fishbein M: Understanding Attitudes and Predicting Social Behavior. New York: Prentice Hall, 1980.

Rosenstock IM: Historical origins of the health belief model. Health Edu Monogr. 1974; 2: 328-335. DOI: 10.1177/109019817400200403.

Manikandan N: Are social distancing, hand washing and wearing masks appropriate measures to mitigate transmission of COVID-19? Vacunas. 2020; 21(2): 136-137.

Talic S, Shah S, Wild H, et al.: Effectiveness of public health measures in reducing the incidence of COVID-19, SARS-CoV-2 transmission, and COVID-19 mortality: Systematic review and meta-analysis. BMJ. 2021; e068302.



How to Cite

Hilton, B. T., B. J. Wiskur, M. W. Brand, J. I. Rojas, R. D. Leckie, M. Trapp, and K. G. Kuhn. “Fear of COVID-19 Among Nonsmokers and smokers/Former Smokers: Implications for Health Promotion Practice”. American Journal of Disaster Medicine, vol. 17, no. 4, July 2023, pp. 313-9, doi:10.5055/ajdm.2022.0446.