Associations of Combustible Cigarette, Electronic Cigarette, and Dual Use With COVID Infection and Severity in the U.S.: A Cross-sectional Analysis of the 2021 National Health Information Survey

Abstract

Given the potential respiratory health risks, the association of COVID infection and the use of combustible cigarettes, electronic nicotine delivery systems (ENDS), and concurrent dual use is a priority for public health. Many published reports have not accounted for known covarying factors. This study sought to calculate adjusted odds ratios for self-reported COVID infection and disease severity as a function of smoking and ENDS use, while accounting for factors known to influence COVID infection and disease severity (i.e., age, sex, race and ethnicity, socioeconomic status and educational attainment, rural or urban environment, self-reported diabetes, COPD, coronary heart disease, and obesity status). Data from the 2021 U.S. National Health Interview Survey, a cross-sectional questionnaire design, were used to calculate both unadjusted and adjusted odds ratios for self-reported COVID infection and severity of symptoms. Results indicate that combustible cigarette use is associated with a lower likelihood of self-reported COVID infection relative to non-use of tobacco products (AOR = .64; 95% CI [.55, .74]), whereas ENDS use is associated with a higher likelihood of self-reported COVID infection (AOR = 1.30; 95% CI [1.04, 1.63]). There was no significant difference in COVID infection among dual users (ENDS and combustible use) when compared with non-users. Adjusting for covarying factors did not substantially change the results. There were no significant differences in COVID disease severity between those of varying smoking status. Future research should examine the relationship between smoking status and COVID infection and disease severity utilizing longitudinal study designs and non-self-report measures of smoking status (e.g., the biomarker cotinine), COVID infection (e.g., positive tests), and disease severity (e.g., hospitalizations, ventilator assistance, mortality, and ongoing symptoms of long COVID).

Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023

“…For example, in 2019, there was an outbreak of acute lung injuries that were primarily attributable to vaping contaminated tetrahydrocannabinol products; yet, before the cause was identified, the Centers for Disease Control and Prevention misattributed this to vaping generally and labeled the disease e-cigarette, or vaping product, use-associated lung injury (EVALI) . The following year, COVID-19, a disease that primarily impairs the respiratory system, prompted concerns that e-cigarette use may increase infection risk and disease severity; however, there is little evidence this was true . Several studies documented short-term increases in the harm perceptions of e-cigarettes following the EVALI outbreak .…”

“…9 The following year, COVID-19, a disease that primarily impairs the respiratory system, prompted concerns that e-cigarette use may increase infection risk and disease severity 10 , 11 , 12 ; however, there is little evidence this was true. 11 , 13 Several studies documented short-term increases in the harm perceptions of e-cigarettes following the EVALI outbreak. 2 How harm perceptions of e-cigarettes have continued to change beyond 2020, in the context of the COVID-19 pandemic (since March 2020) and the growing concern about youth vaping (use of disposable e-cigarettes among young people in England has grown rapidly since June 2021, 14 leading to calls for a ban on disposable vapes 15 and widespread news coverage stating potential risks to youth), and the extent to which changes differ between key population subgroups, is not known.…”