Clinical trial NCT05479383: Tobacco Use and Uptake of COVID-19 Vaccinations
Official title: Tobacco Use and Uptake of COVID-19 Vaccinations in Finland: a General Population Study
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: COVID-19
Smoking
Tobacco Use
Vaccination Refusal
Keywords: Tobacco use
Smoking
COVID-19
SARS-CoV-2
Vaccinations
Cohort studies
Lead sponsor: Finnish Institute for Health and Welfare
Sponsor class: OTHER_GOV
Collaborators: name: Karolinska Institutet
name: Norwegian Institute of Public Health
First posted: 2022-07-29
Enrollment: 42935
Sex: ALL
Minimum age (years): 20
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Permanent residents in Finland aged 20 and over who participated in the FinSote surveys in 2018 and 2020. These are general population samples representative of the Finnish population. The sampling frame was the Population Register (in 2020 the Digital and Population Data Services Agency, created after the merge between the Population Register of Statistics Finland and local register offices), which includes all individuals residing permanently in Finland, including conscripts and people living in institutions.

Brief summary: This is an observational study of participants in two general population health surveys (FinSote 2018 and 2020) who are followed up for their COVID-19 vaccinations or end of follow-up. The primary objective is to examine the association between tobacco use and COVID-19 vaccine uptake and between-dose spacing.

Detailed description: Most high income countries have rolled out COVID-19 vaccinations, with the promise of reducing incident COVID-19 infections and preventing hospitalizations and deaths. A high vaccination coverage is crucial for several reasons: (i) to reduce the number of new COVID-19 cases, (ii) to diminish selective pressures leading to the emergence of new variants of concern, (iii) to prevent severe COVID-19 outcomes, such as hospitalizations and deaths, and (iv) to potentially reduce the risk of post-acute COVID-19 symptoms.

Smokers are at higher risk of COVID-19 hospitalizations and deaths and might thus benefit greatly from high vaccination coverage. However, evidence suggests that they may be less likely to be vaccinated, as smokers are less likely to adhere to preventive measures in general and have lower adherence to other vaccines. Reports of a protective role of smoking on the risk of COVID-19 infection might have also reduced the perceived risks from being infected.

Evidence regarding tobacco use and COVID-19 vaccine hesitancy is mixed. Some studies have shown greater mistrust in COVID-19 vaccine benefits and greater vaccine hesitancy and lower vaccine acceptance compared to non-smokers, while other studies have reported no differences by smoking status or lower levels of vaccine hesitancy in smokers compared to non-smokers. Few studies have examined the relationship between tobacco use and vaccine uptake, showing that smokers had higher odds of being vaccinated. These studies, however, are not representative of the general population and relied on self-reported vaccination status, resulting in higher risk of selection and information bias.

The investigators will expand current knowledge by examining two forms of tobacco use in Finland -smoking and smokeless tobacco use (snus)- and by analysing the spacing between vaccine doses. The study will use data from nationally representative surveys in Finland linked to vaccination registries, which reduces the risk of selection and information bias.

Eligibility criteria: Inclusion Criteria:

* Permanent residents of Finland
* Registered in the Population Register at the moment of sampling
* Aged 20 and over
* Participated in the FinSote surveys in 2018 or 2020
* Provided consent for register linkage

Exclusion Criteria:

* Temporary residents in Finland or tourists
* Age less than 20 years old
* Did not participate in FinSote surveys in 2018, 2019 and 2020
* Did not provide consent for register linkage

Primary outcomes:
measure: Vaccination uptake of at least two doses of a COVID-19 vaccine
timeFrame: Baseline until date of vaccination or May 31, 2022
Secondary outcomes:
measure: Vaccination uptake of at least one dose of a COVID-19 vaccine
timeFrame: Baseline until date of vaccination or May 31, 2022
measure: Vaccination uptake of complete COVID-19 vaccination scheme (two doses and a booster dose)
timeFrame: Baseline until date of vaccination or May 31, 2022
measure: Spacing of first and second COVID-19 dose
timeFrame: Baseline until date of vaccination or May 31, 2022
measure: Spacing of second dose and booster dose of the COVID-19 vaccine
timeFrame: Baseline until date of vaccination or May 31, 2022
Other outcomes:
Locations:
city: Helsinki
country: Finland
facility: Finnish Institute for Health and Welfare
state: Uusimaa
Study officials:
affiliation: Finnish Institute for Health and Welfare
name: Sakari Karvonen, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Simons D, Shahab L, Brown J, Perski O. The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7). Addiction. 2021 Jun;116(6):1319-1368. doi: 10.1111/add.15276. Epub 2020 Nov 17.
citation: Jackson SE, Paul E, Brown J, Steptoe A, Fancourt D. Negative Vaccine Attitudes and Intentions to Vaccinate Against Covid-19 in Relation to Smoking Status: A Population Survey of UK Adults. Nicotine Tob Res. 2021 Aug 18;23(9):1623-1628. doi: 10.1093/ntr/ntab039.
citation: Krebs NM, D'Souza G, Bordner C, Allen SI, Hobkirk AL, Foulds J, Yingst JM. COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users. Tob Use Insights. 2021 Dec 20;14:1179173X211068027. doi: 10.1177/1179173X211068027. eCollection 2021.
citation: Ali M, Ahmed S, Bonna AS, Sarkar AS, Islam MA, Urmi TA, Proma TS. Parental coronavirus disease vaccine hesitancy for children in Bangladesh: a cross-sectional study. F1000Res. 2022 Jan 25;11:90. doi: 10.12688/f1000research.76181.2. eCollection 2022.
citation: Oruc MA, Ozturk O. Attitudes of health care professionals towards COVID-19 vaccine - a sequence from Turkey. Hum Vaccin Immunother. 2021 Oct 3;17(10):3377-3383. doi: 10.1080/21645515.2021.1928462. Epub 2021 Jun 18.
citation: Wu J, Li Q, Silver Tarimo C, Wang M, Gu J, Wei W, Ma M, Zhao L, Mu Z, Miao Y. COVID-19 Vaccine Hesitancy Among Chinese Population: A Large-Scale National Study. Front Immunol. 2021 Nov 29;12:781161. doi: 10.3389/fimmu.2021.781161. eCollection 2021.
citation: Luk TT, Zhao S, Wu Y, Wong JY, Wang MP, Lam TH. Prevalence and determinants of SARS-CoV-2 vaccine hesitancy in Hong Kong: A population-based survey. Vaccine. 2021 Jun 16;39(27):3602-3607. doi: 10.1016/j.vaccine.2021.05.036. Epub 2021 May 18.
citation: Wisniak A, Baysson H, Pullen N, Nehme M, Pennacchio F, Zaballa ME, Guessous I, Stringhini S; Specchio-COVID19 study group. COVID-19 vaccination acceptance in the canton of Geneva: a cross-sectional population-based study. Swiss Med Wkly. 2021 Dec 14;151:w30080. doi: 10.4414/smw.2021.w30080. eCollection 2021 Dec 6.
citation: Ishimaru T, Okawara M, Ando H, Hino A, Nagata T, Tateishi S, Tsuji M, Matsuda S, Fujino Y; CORoNaWork Project. Gender differences in the determinants of willingness to get the COVID-19 vaccine among the working-age population in Japan. Hum Vaccin Immunother. 2021 Nov 2;17(11):3975-3981. doi: 10.1080/21645515.2021.1947098. Epub 2021 Jul 2.
citation: Ko T, Dendle C, Woolley I, Morand E, Antony A. SARS-COV-2 vaccine acceptance in patients with rheumatic diseases: a cross-sectional study. Hum Vaccin Immunother. 2021 Nov 2;17(11):4048-4056. doi: 10.1080/21645515.2021.1958611. Epub 2021 Aug 6.
citation: Tan LF, Huak CY, Siow I, Tan AJ, Venugopalan PM, Premkumar A, Seetharaman SK, Tan BYQ. The road to achieving herd immunity: factors associated with Singapore residents' uptake and hesitancy of the COVID-19 vaccination. Expert Rev Vaccines. 2022 Apr;21(4):561-567. doi: 10.1080/14760584.2022.2021883. Epub 2022 Jan 11.
citation: Tiirinki H, Viita-Aho M, Tynkkynen LK, Sovala M, Jormanainen V, Keskimaki I. COVID-19 in Finland: Vaccination strategy as part of the wider governing of the pandemic. Health Policy Technol. 2022 Jun;11(2):100631. doi: 10.1016/j.hlpt.2022.100631. Epub 2022 Apr 14.