Smoking and Vaping Among a National Sample of U.S. Adults During the COVID-19 Pandemic

Kalkhoran, S.; Levy, D. E.; Rigotti, N. A.

Introduction: With concerns about cigarette smoking as a risk factor for severe disease from COVID-19, understanding nicotine and tobacco use patterns is important for preventive efforts. We aimed to understand changes in product use behaviors among U.S. adult combustible cigarette smokers and electronic cigarette (e-cigarette) users. Methods: In August 2020, we conducted a cross-sectional survey of a nationally-representative sample of adults age >18 in the NORC AmeriSpeak Panel who reported past 6-month use of combustible cigarettes or e-cigarettes. Multivariable logistic regression assessed factors associated with increased product use and quit attempts since hearing about COVID-19. Results: 1024 past 6-month cigarette smokers and/or 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. 26% 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, 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. Others, 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.