COVID-19 and tobacco products use among US adults, 2021 National Health
Interview Survey
Abstract
Objective: A nationally representative sample of US adults was used to
examine the prevalence of COVID-19 cases, testing, symptoms, and vaccine
uptake, and associations with tobacco product use. Methods: Data came
from the 2021 National Health Interview Survey. The 2021 Sample Adult
component included 29,482 participants with a response rate of 50.9%.
We investigated COVID-19-related outcomes by tobacco product use status
and reported national estimates. Multivariable regression models were
performed accounting for demographics (e.g., age, sex, poverty level),
serious psychological distress, disability, and chronic health
condition. Results: In our regression analyses, odds of self-reported
COVID-19 infection were significantly lower for combustible tobacco
product users (vs. non-users; Adjusted Odds ratio [AOR=0.73; 95%
confidence interval [CI]=0.62-0.85]. Combustible tobacco users
also were less likely to report ever testing for COVID-19 (AOR=0.88;
95% CI=0.79-0.98), ever testing positive for COVID-19 (AOR =0.66; 95%
CI=0.56-0.77), and ever receiving COVID-19 vaccine (AOR=0.58; 95%
CI=0.51-0.66) compared to their non-user peers. Compared to non-users,
users of any type of tobacco who contracted COVID-19 had higher odds of
losing smell (AOR=1.36; 95%CI=1.04-1.77), which was more pronounced
among exclusive e-cigarette users. The odds of receiving vaccine were
lower for all current exclusive tobacco product users compared to
non-users (AORs= 0.40 to 0.70). Conclusions: Continued monitoring of
tobacco product use amid the COVID-19 pandemic is crucial to inform
public health policies and programs. In addition, efforts to promote
COVID-19 vaccination, especially among tobacco product users, are
warranted.