Pandemic stress & tobacco harm reduction

Pandemic stress & tobacco harm reduction

Outline of person surrounded by hazard symbols
We can’t make perfect choices all the time.
Base image: Risk, CC-BY Nithinan Tatah

Candy is a queer, nonbinary Iranian person living in Oakland and working remotely as a teacher. Their former use of cigarettes was strongly associated with situations where they felt heightened anxiety. In these instances, Candy utilized cigarette smoking as a tool to take some space away from the situation and calm down. Though this was not a regular occurrence in the past, it is necessary to contextualize the role of stress in Candy’s current use:

“Like, ’cause my rent is more than half my paycheck, and my partners had to move away because they can’t afford it here… and also that we’ve been in our homes for a year because we just couldn’t get it together to do things better… But if I didn’t need to grasp at whatever I could to cope with what’s happening around me, there would be no benefit to this for me, and I would have no desire to smoke or anything else.”

Candy’s narrative reflects resource scarcity — their rent is half their paycheck and their partners can no longer afford to live in the state. The pandemic has been stressful for Candy, and this resource-related stress and isolation spurred a desire to smoke cigarettes again.

However, cigarettes are expensive — the cost per pack has increased by about $3 since the last time they bought one over a year ago. A former coworker introduced Candy to oral nicotine pouches, which are $2 per tin of about 20 pouches. In the Bay Area, that means that one nicotine pouch is about 80% cheaper than one cigarette ($.10/pouch vs $.50-.60/cigarette).

When I asked Candy, “If you had to say one reason right now to tell someone else why you use your nicotine pouches, what would it be?” they replied:

“Harm reduction. Yeah, the pandemic is hard. I’m having a time. Of all of the things I could use to cope, this feels the least destructive. It’s less expensive, and it feels like it takes less of a toll on my body than other things that I could be using. It feels more responsible than like, drinking a bunch, ’cause you know, if I’m teaching, I can do this while I do that…”

The decision to switch from cigarettes to nicotine pouches is a choice with straightforward implications of harm reduction. Candy had family members experience terminal cancer and noted that Covid-19 is a virus affecting the lungs, so switching to a non-inhaled product with less hand-to-mouth contact was a good option for them. Furthermore, the pouches weren’t a financial burden for Candy, and fit into the new rhythms of their everyday life teaching remotely and sheltering in place.

Candy commented on the nicotine effects as being useful and grounding, and specifically remarked that nicotine and tobacco use are better (for their body and for their job) than excessive drinking — a perspective shared by several other participants too.

This indicates a complex process of considerations around harm and risk when it comes to nicotine and tobacco use for many of the people we’ve spoken to in this study, revealing the breadth of harm reduction and its implications. When I asked Candy what they meant by “harm reduction,” they put it this way:

“I feel like if I tried to set the expectation of myself that I’m just not going to use any kinds of substances or not do things that I know are not good for me, like, period, full stop, that’s not a realistic expectation. And in the past, I’ve tried to make decisions like that… What happens is that it becomes all that I think about. And I don’t do it for a while, and then I give in and go way overboard, and it’s worse… I want to take care of myself. I want to make good choices. I can’t make perfect choices all the time. So, I’m going to do my best to make better ones.”