Background:
There is substantial evidence suggesting that smoking is a risk factor for severe COVID-19.

Objective:
We aimed to explore how smoking status affects the perceived susceptibility and perceived severity of COVID-19 among the Armenian adult population, which has one of the highest smoking prevalence in the European region (27.9% among the adult population and 51.5% among males).

Methods:
A nationwide phone survey was conducted in Armenia in 2021. The questions on sociodemographic characteristics, smoking, COVID-19 susceptibility, severity, knowledge and vaccination were included in a multi-domain structured survey instrument. Smoking status was categorized as current smokers (smoking every day or less than every day) and non-smokers including quitters). Questions on the perceived risk of contracting COVID-19 (susceptibility) and the perceived severity of COVID-19 disease (severity) were used to calculate COVID-19 perceived susceptibility and severity scores (0–3) and were used in bivariate and multivariate linear regression analyses.

Results:
Overall, 3483 people participated in the phone survey of which 16.8% (n=571) were current smokers, 71.0% (n=2472) were females, and 11.6% (393) were vaccinated against COVID-19. In bivariate analyses, current smokers compared with nonsmokers had significantly lower scores for COVID-19 perceived susceptibility (1.2 vs 1.3, p=0.042) and perceived severity (1.7 vs 1.8, p=0.002). In the multivariable analyses, the COVID-19 perceived severity score was negatively associated with being a current smoker (b= -0.11, p=0.034), when adjusted for age, gender, income level, education level, employment status, place of residence, COVID-19 knowledge and vaccination status. The perceived susceptibility score was not significantly associated with the smoking status in the adjusted analyses.

Conclusions:
The study found a negative adjusted association between smoking and the level of perceived severity of COVID-19. This finding coupled with the evidence that smoking results: in severe COVID-19 experience, and emphasizes the importance of targeted interventions to influence adequate COVID-19 severity perception among the smoker population in Armenia.