Background:
The emerging literature suggests that smokers are less likely to comply with COVID-19 infection prevention and control (IPC) behaviors.

Objective:
Given the high smoking rates in Armenia (28.0% among the general population and 51.7% among males) we aimed to explore the compliance to the COVID-19 protective behaviors among smoker and non-smoker adults in the country.

Methods:
A nationwide phone survey was conducted in Armenia in 2021. Two-stage cluster sampling was performed to recruit the study participants. The study instrument included questions on sociodemographic characteristics, COVID-19 knowledge and vaccination status, smoking and COVID-19 protective behaviors. Participants were asked about the frequency (always/usually vs sometimes/rarely/never) of wearing masks, washing hands with soap and water for at least 20 seconds, participating in social gatherings and maintaining at least 1.5 m social distance in the past 14 days. Participants were categorized as current smokers (daily/less than daily) and non-smokers (never smokers/quitters). Bivariate and multivariate analyses were performed.

Results:
Overall, 3483 participants completed the survey, of which 16.8% (n=571) were current smokers, and 71.0% (n=2472) were females. The mean age was 49.5 years. Generally, the respondents reported adequate compliance with the examined protective behaviors: washing hands (91.2%, n=3099), avoiding social 11 Tobacco Prevention & Cessation | Abstract Book gatherings (74.2%, n=2515), wearing masks (51.7%, n=1752) and maintaining social distance (42.0%, n=1418). In bivariate analysis, smokers compared with non-smokers were less likely to comply with protective behaviors with a significant difference in wearing masks (45.8% vs 52.9%, p=0.002) and avoiding social gatherings (62.0% vs 75.6%, p<0.001). However, the multivariate analysis showed no significant associations between those protective behaviors and the smoking status of respondents, when adjusted for the sociodemographic characteristics, COVID-19 vaccination status, and knowledge.

Conclusions:
Future studies are needed to further explore the compliance level with the COVID-19 protective IPC behaviors among smokers and non-smokers to appropriately guide public health interventions and targeted health communication campaigns.