A year after COVID-19 upended life for millions of Americans, there are troubling signs that the coronavirus may have also slowed progress against another deadly health threat: smoking.

Fewer smokers called quit-smoking hotlines last year and some smoked more, contributing to an unusual bump in cigarette sales — all in the middle of the stress, anxiety and uncertainty from the pandemic.

“It’s hard for folks to quit using tobacco in the best of times, so what happens when life is suddenly turned upside down?” said Jen Cash, who oversees Minnesota’s anti-tobacco programs.