Smoking and E-Cigarette Use Among U.S. Adults During the COVID-19 Pandemic

Kalkhoran, Sara; Levy, Douglas E.; Rigotti, Nancy A.

Introduction With concerns about tobacco use being a risk factor for severe disease from coronavirus disease 2019 (COVID-19), understanding nicotine and tobacco use patterns is important for preventive efforts. This study aims to understand changes in combustible cigarette and e-cigarette use among U.S. adults. Methods In August 2020, a cross-sectional survey of a nationally representative sample of adults aged ≥18 years in the National Opinion Research Center's AmeriSpeak Panel who reported past 6–month use of combustible cigarettes or e-cigarettes was conducted. Multivariable logistic regression assessed factors associated with increased product use and quit attempts since hearing about COVID-19. Results A total of 1,024 past 6–month cigarette smokers/e-cigarette users were surveyed. Among cigarette smokers, 45% reported no change in cigarette smoking and 33% increased cigarette smoking since hearing about COVID-19. Higher stress was associated with increased cigarette smoking. Among e-cigarette users, 41% reported no change in and 23% reported increasing e-cigarette use. Twenty-six percent of cigarette smokers and 41% of e-cigarette users tried to quit because of COVID-19. Higher perceived risk of COVID-19 was associated with attempts to quit combustible cigarettes (AOR=2.37, 95% CI=1.59, 3.55) and e-cigarettes (AOR=3.14, 95% CI=1.73, 5.70). Conclusions Cigarette and e-cigarette use patterns varied in response to the COVID-19 pandemic. Most cigarette smokers and e-cigarette users perceived product use as increasing COVID-19-related health risks, and this was associated with attempts to quit. Some cigarette smokers, especially those reporting higher stress, increased product use. Proactive provision of cessation support to smokers and e-cigarette users may help mitigate stress-related increases in product use during the COVID-19 pandemic.