Impact of COVID-19 on Individual Behavior and Household Exposure Related to Smoking, Vaping and Marijuana Use Among Adults with Asthma

Abstract

Rationale: Across the United States, household, employment, and social routines have been substantially altered due to the emergence the COVID-19 pandemic. These altered routines may drive changes in smoking behaviors. The purpose of this study was to examine self-reported behavior changes and household exposure related to tobacco, vaping and marijuana use during the COVID-19 pandemic in a sample of adults with asthma. Method: An online, cross-sectional survey was conducted with those ≥18 years old, currently diagnosed with asthma, and able to read and write in English. The survey invitation was shared via email, social media, and ResearchMatch. Participants completed the Asthma Control Test (ACT) and items regarding their smoking behavior before and since the pandemic. Items to assess cigarette, marijuana, and vaping use included: “Do you smoke cigarettes?”, “During the past 4 weeks, did you use marijuana/cannabis (e.g., joint, blunt, pipe, bong)?”, “During the past 4 weeks did you use vaping products?”. Questions also assessed presence of secondhand smoking behaviors in the home and if these behaviors had changed since the COVID-19 pandemic. ACT scores were dichotomized: ≤19 (uncontrolled asthma) vs. ≥20 (controlled asthma). Statistical analyses included descriptive statistics, chi squared statistics, and logistic regression. Results: Respondents (N=795) had a mean age of 43 years and were primarily female (81%), white (83%), and college educated (71%). Approximately 56% reported having an asthma exacerbation since COVID-19. Of participants, 4%, 5%, and 14% reported smoking cigarettes, vaping, and marijuana use, respectively. Household behaviors for cigarettes, vaping, and marijuana were 12%, 8%, and 15% respectively. For associations between smoking behavior and reduced asthma control, the adjusted odds ratios [CI] for cigarettes, vaping and marijuana were 5.79 (95% CI=2.28-14.66), 2.15 (95% CI=1.06-2.50), and 1.54 (95% CI=0.99-2.41), respectively. The adjusted odds ratio for current household smoking and reduced asthma control was 2.07 (95% CI=1.27-3.39). Conclusions: The onset of the COVID-19 pandemic in the US and the resulting routine changes have brought about substantial increases in smoking behaviors (tobacco, vaping, and marijuana). In addition to supporting the well-known impact of cigarette use on asthma, individual use of marijuana and vaping were associated with uncontrolled asthma. Healthcare providers should remain diligent in asking about smoking behavior changes in the household during the COVID-19 pandemic.