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

Susette A Moyers; Micah Hartwell; Ashleigh Chiaf; Benjamin Greiner; Jason A Oliver; Julie M Croff

doi:10.1177/1179173X231179675

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

Tob Use Insights. 2023 Jun 7:16:1179173X231179675. doi: 10.1177/1179173X231179675. eCollection 2023.

Authors

Susette A Moyers¹, Micah Hartwell^{2

3}, Ashleigh Chiaf¹, Benjamin Greiner⁴, Jason A Oliver^{2

5

6}, Julie M Croff¹

Affiliations

¹ Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
² Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
³ Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA.
⁴ Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
⁵ TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA.
⁶ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

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).

Keywords: COVID infection; COVID severity; combustible cigarette use; electronic nicotine delivery system use; smoking.

Abstract

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