However, human research studies are lacking on concurrent e-cigarette and cannabis use and COVID-19-related health outcomes.Research has linked respiratory symptoms or disease with adult current e-cigarette use,current cannabis combustible smoking and vaping , and lifetime e-cigarette and cannabis use.College student e-cigarette use and cannabis smoking and vaping reached historical highs between 2017 and 2019.Currently, 22% and 14% of students report past 30-day nicotine and cannabis vaping, respectively . Over one-in-four  students report current cannabis use including other routes of administration,with 1-in-17  reporting daily cannabis use. While current dual use of e-cigarettes and combustible cigarettes has been associated with increased risk of COVID-19 symptoms and diagnosis among 13–24-year-olds , less is known about COVID-19-related risks associated with concurrent e-cigarette and cannabis grow tray use. Given the high prevalence of e-cigarette and cannabis use among college students,research is needed to assess the associations between concurrent use and COVID-19-related outcomes.

This investigation assessed whether current e-cigarette and cannabis use was associated with COVID-19 symptomatology, testing, and diagnosis among college student current e-cigarette users. We hypothesized concurrent users of e-cigarettes and cannabis would be at increased odds of experiencing COVID-19 symptoms and having a prior positive COVID- 19 diagnosis compared with exclusive e-cigarette users. Additionally, we assessed whether frequency of e-cigarette and cannabis use was associated with COVID-19 symptoms, testing, and diagnosis. We hypothesized that when compared to infrequent exclusive e-cigarette users, intermediate or daily exclusive e-cigarette users as well as infrequent, intermediate, and frequent concurrent e-cigarette and cannabis users would be at increased odds of reporting COVID-19 symptoms and diagnosis. Based on COVID-19 random selection testing policies at each university during the study period, we posited there would be no difference in COVID-19 testing between the exclusive e-cigarette and concurrent use groups.

Data are from a cross-sectional, online survey conducted October- December 2020. Participants were college students  ages 18–26 years from four geographically diverse, large U.S. public universities  who reported current e-cigarette use. Institutional review boards  at each university independently vetted and approved all study procedures by November 2020; data collection occurred after respective IRB approval. Students at each university had the option to complete their coursework online, vertical grow system in-person, or a hybrid model. Students residing in university housing/ residences were allowed to remain on each of the respective campuses during the data collection period. COVID-19 testing programs at each of the four respective campuses were similar and required randomly selected students to undergo testing. Eligible participants were recruited by disseminating emails via campus-wide listservs and undergraduate and graduate course listservs. Participant recruitment strategically took place at least over one month into the fall semester due to the study’s aim of capturing past 30-day behavior during the academic year.

Solicitations sought students between the ages of 18–26 who “vape or use e-cigarettes” and were currently on campus. The recruitment email included a website link to a survey hosted on Qualtrics , and stated the estimated completion time was 10 minutes. Potential participants were provided with a research information sheet which they needed to acknowledge prior to proceeding to the survey. The information sheet reinforced the recruitment email’s information.However, sample size calculations using a 95% confidence interval , 100,000-population size, and a conservative 50–50 split considering the population is relatively varied , assert a minimum of 383 completed surveys were needed to have sufficient power for statistical analysis. This study provides evidence college student e-cigarette users who concurrently use cannabis in the past 30-days are at greater likelihood of experiencing COVID-19 symptoms and having a positive COVID-19 diagnosis, compared with exclusive e-cigarette users.