Assessment of Exclusive, Dual, and Polytobacco E-Cigarette Use and COVID-19 Outcomes Among College Students.

Purpose: This study examined current (past 30-day) dual- and polytobacco use patterns and COVID-19 symptomatology, testing, and diagnosis status among college student electronic cigarette (e-cigarette) users.

Design: Cross-sectional online questionnaire administered during October-December 2020. Setting: Four large, U.S. public universities in geographically diverse locations. Sample: College students (N=756) ages 18-24 who reported current e-cigarette use. Measures: Current use of e-cigarettes, combustible cigarettes, and cigars, and self-reported COVID-19 symptomatology, testing, and diagnosis status were measured. Analysis: Multivariable logistic regression models accounting for students' demographics, university site, fraternity/sorority membership, and current residence.

Results: Over half (53.6%) of students were exclusive e-cigarette users, 20.4% were dual e-cigarette and combustible cigarette users, 4.6% were dual e-cigarette and cigar users, and 21.4% were poly users of e-cigarettes, combustible cigarettes, and cigars. Compared to exclusive e-cigarette users, dual users of e-cigarettes and combustible cigarettes (AOR=2.12, 95%CI=1.05-4.27) and poly users of e-cigarettes, combustible cigarettes, and cigars (AOR=3.70, 95%CI=1.78-7.70) had increased odds of COVID-19 symptomatology, even when accounting for covariates. While current tobacco use groups did not differ based on COVID-19 testing, polytobacco users had significantly increased odds (AOR=2.16, 95%CI=1.11-4.20) of having received a positive COVID-19 diagnosis.

Conclusion: Given use of two or more tobacco products increased COVID-19-related risks, results underscore the need to prevent dual- and polytobacco use behaviors in college student e-cigarette users.