Abstract
Background: Tobacco use is the single most preventable cause of cardiovascular disease mortality and morbidity. However, evidence on associations of tobacco/nicotine and cannabis use and COVID-19 infection and severity among youth is limited. It is also unclear if associations between tobacco and cannabis use with COVID-19 are similar to other acute respiratory infections (ARIs). Methods: We used data from Fall-2020 and Spring-2021 ACHA-NCHA surveys. Multivariable multinomial and binary logistic regression models were used to estimate the odds of COVID-19 infection/severity and other ARIs by tobacco/nicotine product or cannabis use within last 3 months. Results: Of 69,868 students ages 18-24, 70% were female, 0.7% with COVID-19 confirmed-severe, 5% confirmed-moderate, 8% confirmed-mild/asymptomatic, 23% with any ARIs, 18% using any tobacco/nicotine products, and 16% using cannabis. With multiple adjustments, users of only e-cigarettes, only other tobacco products, or dual/poly products (vs. non-users) were nearly 2 times more likely to have COVID-19 (vs. confirmed-negative). A similar pattern of associations was observed for tobacco/nicotine product use and ARIs. Cannabis use had no association with COVID-19 infection, but cannabis users had 8% higher odds of ARIs than non-users. Of 9,380 COVID-19 confirmed students, no association of tobacco/nicotine product use with COVID-19 severity was observed, but cannabis users had 17% higher odds of severe/moderate (vs. mild/asymptomatic) symptoms than non-users. Conclusion: Aong US college students, e-cigarette or dual/poly-product users are more likely to have COVID-19 and other acute respiratory infections. Cannabis users were more likely to have more severe COVID-19 symptoms than non-users; they were also more likely to have other acute respiratory infections.
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