Interestingly, this study found those who were male and White had the highest percentages of having a COVID-19 diagnosis. Notably, the literature indicates the highest prevalence of EVALI cases are among those who are male and White . Although this diagnosis was not assessed in this study, future work should examine the associations of e-cigarette and cannabis use and COVID-19 diagnoses and other specific diagnoses such as EVALI or pneumonia. Other explanations for higher odds of concurrent users having a COVID-19 diagnosis are behavior-related, including tendencies of sharing devices with others and hand-to-lip contact while using these products , 2021, which also increases COVID-19 risk via contact and fomite transmission . About 1-in-2 young adult lifetime e-cigarette users report sharing devices with others , which may explain this study’s finding that fraternity/sorority members had a higher likelihood of reporting a COVID-19 diagnosis.
Moreover, e-cigarette use may ultimately increase risk-taking behaviors during young adulthood, including but not limited to concurrent cannabis grow facility use . Research indicates dual e-cigarette and combustible cigarette use is associated with poor compliance with COVID-19- related social distancing behaviors . Thus, it is highly likely e-cigarette users who engage in concurrent use of cannabis did not engage in recommended preventive health behaviors . While this study has several strengths, limitations should be noted. First, while students were enrolled at four geographically diverse universities across the U.S., our cross-sectional sample is not nationally representative and therefore our results are not generalizable to all U.S. student e-cigarette users. Longitudinal research is needed to assess causal associations between e-cigarette and cannabis use patterns with COVID-19-related outcomes. In a similar vein, we were unable to objectively measure COVID-19 symptoms, testing, and diagnosis.
For example, the survey language specifically asked whether students were currently experiencing any COVID-19 symptoms from the Centers for Disease Control and Prevention’s COVID-19 symptoms list ; but since some of the symptoms were nonspecific to COVID-19, students may have reported a symptom while not having COVID-19 concerns. Additionally, since our student sample included those who currently used e-cigarettes, we were unable to compare exclusive e-cigarette use versus non-use nor exclusive cannabis use. We assessed self-reported e-cigarette use frequency in number of days and cannabis use frequency in number of times used in the past 30 days and used categorical cutpoints to minimize the potential for recall bias. We used standard national survey question language to collect data on past 30-day cannabis use frequency based on number of times . Thus, we did not collect cannabis use frequency in number of days, and suggest this as a measure to be used in further research. Additionally, we did not collect information on cannabis grow system use route . Future research should consider the use of biomarkers,and THC carboxylic acid the major metabolite of delta-9-tetrahydrocannabinol and patient medical records to cross-validate self-reported responses. Additionally, studies should take into consideration overall preventive health behaviors and statewide and local policies that may reduce infectious disease risk.
Due to our recruitment methods , we could not calculate response rates, which resulted in varying participation rates that may have biased the sample. All four university campuses remained “open” during data collection. While we did not collect course engagement data , future research should account for frequency of in-person class participation, which may have increased COVID-19 exposure and susceptibility. We did not have access to information on COVID-19 random testing rates at each university. COVID-19 testing rates may have varied at each campus based on test availability and accessibility on and off campuses.Cannabis use is on the rise, among some groups of US adolescents, due to increased availability, less overall negative perceptions, and a proliferation of e-cigarettes and vaping . Recent population studies show rates of use in 8th and 10th grades at 15 % and 34 % respectively . Past-year cannabis use among justice-involved youth steadily increased between 2002–2017 and JIY report higher rates of cannabis use than their same-age non-justice-involved peers; often starting cannabis use by age 13 . As part of the fourth wave of juvenile justice reform , legislation has increasingly moved toward diverting youth from detention to community supervision.