Concurrent Use of E-cigarettes and Cannabis and Associated COVID-19 Symptoms, Testing, and Diagnosis among Student E-Cigarette Users at Four U.S. Universities

Abstract Introduction This investigation assessed whether current (past 30-day) electronic cigarette (e-cigarette) and cannabis use was associated with coronavirus disease 2019 (COVID-19) symptomatology, testing, and diagnosis among college student e-cigarette users. Methods Participants were 18-26-year-old college student e-cigarette users attending four geographically diverse, large U.S. public universities during October-December 2020 (N=800). Multivariable logistic regression models explored associations between exclusive e-cigarette use and concurrent e-cigarette and cannabis use and COVID-19 symptoms, testing, and diagnosis. Models controlled for demographics, university site, and current use of combustible cigarettes, cigars, and smokeless tobacco. Results Over half of student e-cigarette users (52.0%) concurrently used cannabis. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 3.53 times more likely (95%CI=1.96-6.36) to report COVID-19 symptoms, after adjusting for covariates. Compared to infrequent exclusive e-cigarette users, infrequent concurrent users (AOR=4.72, 95%CI=1.31-17.00), intermediate concurrent users (AOR=5.10, 95%CI=1.37-18.97), and frequent concurrent users (AOR=7.44, 95%CI=2.06-26.84) were at increased odds of reporting COVID-19 symptoms. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 1.85 times more likely (95%CI=1.15-2.98) to report a COVID-19 diagnosis. Intermediate concurrent users (AOR=2.88, 95%CI=1.13-7.35) and frequent concurrent users (AOR=3.22, 95%CI=1.32-7.87) were at increased odds of reporting a COVID-19 diagnosis, compared to infrequent exclusive e-cigarette users. Conclusions Concurrent use of e-cigarettes and cannabis may be an underlying risk factor of COVID-19 symptomatology and diagnosis, with more pronounced odds found among intermediate and frequent users. Results highlight the need to educate students about the impacts of e-cigarette and cannabis use on respiratory, immune, and overall health.