Background:
The COVID-19 pandemic has impacted almost all aspects of our lives. We wished to examine the impact of the pandemic on smoking behaviors across 21 countries.

Method:
A random sampling approach followed by snowball sampling was used to obtain a wide range of participant characteristics from the general population. The online survey was distributed using a range of methods. The majority of countries from where data were collected had declared a state of emergency for COVID-19. We asked participants between the months of April and June 2020, whether their smoking habits changed during the pandemic when governmental lockdowns or quarantines were in place. We asked how many cigarettes per day participants smoked before the pandemic compared to the present period.

Results:
Participants were 9150, mean age was 36.9 (13.3) years and the majority were females (77.7%). Smoking rates ranged from 1.4% in Hong Kong to 32.7% in Romania. A repeated-measures ANOVA of country-by-time (before the pandemic vs currently) of the number of cigarettes smoked was significant [F(36,1533)=4.12; p<0.001; η2=0.09].

Conclusions:
The countries that drove the interaction and presented with substantial increases in cigarettes smoked per day were: Cyprus, Greece, Austria, France, Latvia and Ireland. In the rest of the countries, participants did not change their smoking behaviour during this period, and these were: Switzerland, UK, Turkey, Germany, Spain, Italy, Portugal, Finland, Poland, Romania, Colombia, Hungary, USA, Hong Kong, and Montenegro.