Beliefs on COVID-19 Among Electronic Cigarette Users: Behavioral Responses and Implications for COVID Prevention and E-Cigarette Interventions

• Published date: 01 April 2021
• DOI: 10.1177/0022042620977828
• Date: 01 April 2021
• Subject Matter: Articles

https://doi.org/10.1177/0022042620977828

Journal of Drug Issues

2021, Vol. 51(2) 280 –296

© The Author(s) 2020

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DOI: 10.1177/0022042620977828

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Article

Beliefs on COVID-19 Among

Electronic Cigarette Users:

Behavioral Responses and

Implications for COVID Prevention

and E-Cigarette Interventions

Brian C. Kelly1, Mark Pawson1, and Mike Vuolo2

Abstract

E-cigarette users’ beliefs about COVID-19 may shape their responses to the pandemic and their

e-cigarette consumption. A U.S. national cross-sectional survey of 562 e-cigarette users was

conducted in April 2020. Participants self-reported nicotine consumption, COVID-19 beliefs,

beliefs about e-cigarettes, social distancing, COVID-19 disruptions, cessation considerations,

and individual characteristics. Ordinary least squares (OLS) regression provided unstandardized,

and standardized coefficients. Frequency of e-cigarette use is inversely associated with beliefs

COVID-19 is relevant (β = −0.215). Beliefs e-cigarettes are addictive, harmful, or pose a risk

to future health were positively associated with beliefs COVID-19 is relevant (β = 0.171;

β = 0.164; β = 0.203), beliefs the media are truthful on COVID-19 (β = 0.133; β = 0.136;

β = 0.137), and beliefs e-cigarette users are at greater risk (β = 0.279; β = 0.411; β =

0.447). All three COVID-19 beliefs (COVID relevant; media truthful; and greater risk) were

positively associated with social distancing (β = 0.307; β = 0.259; β = 0.115), work disruptions

(β = 0.134; β = 0.135; β = 0.130), family disruptions (β = 0.232; β = 0.131; β = 0.164),

friendship disruptions (β = 0.214; β = 0.139; β = 0.133), and considerations of quitting (β =

0.250; β = 0.222; β = 0.620). Strong associations between e-cigarette beliefs and COVID-19

beliefs exist. COVID-19 beliefs are associated with behavioral responses, such as social distancing

and considerations of e-cigarette cessation. Interventions may be able to leverage COVID-19

beliefs to reduce e-cigarette consumption or promote cessation during the pandemic.

Keywords

beliefs, e-cigarettes, COVID-19, risk

Introduction

The emergence of the COVID-19 pandemic has been unsettling for many. For e-cigarette

users, the emergence of illness and hospitalizations for respiratory distress caused by COVID-

19 comes on the heels of reports of lung injuries due to vaping (i.e., E-cigarette or Vaping

1Purdue University, West Lafayette, IN, USA

2The Ohio State University, Columbus, OH, USA

Corresponding Author:

Brian C. Kelly, Department of Sociology, Purdue University, 700 W State St. West Lafayette, IN 47907, USA.

Email: bckelly@purdue.edu

977828JODXXX10.1177/0022042620977828Journal of Drug IssuesKelly et al.

research-article2020

Kelly et al. 281

Product Use–Associated Lung Injury, or EVALI) during the prior autumn. The need for

research on emergent issues—not merely among the general population but key subpopula-

tions such as e-cigarette and tobacco users—is a key priority for COVID-19 responses (Lipsitch

et al., 2020; Volkow, 2020) and also for reformulating prevention and intervention work on

nicotine use within the context of a pandemic. There have been indications that tobacco and

nicotine consumption may shape outcomes within the context of the pandemic (Hefler &

Gartner, 2020). The use of nicotine products is relevant for viral illnesses, as studies show that

smokers are 34% more likely than nonsmokers to contract the flu and are also consistently

associated with higher risk of influenza-related hospitalization (Han et al., 2019; Lawrence

et al., 2019). Scholars have indicated that smokers and e-cigarette users may be at increased

risk of severe COVID-19 infection and worse outcomes (Brake et al., 2020; Lewis, 2020;

Patanavanich & Glantz, 2020). In early research emerging from China, one study found a rela-

tionship between history of smoking and disease progression (Liu et al., 2020). Another study

found a larger proportion of severe cases or cases of primary composite end point (intensive

care unit [ICU] admission, ventilation, or death) were current smokers in comparison with

nonsevere cases (Guan et al., 2020). Yet, a meta-analysis concluded that smoking may not be

associated with severity of COVID-19 (Lippi & Henry, 2020). In sum, the use of nicotine

products may be relevant for disease progression and related COVID-19 outcomes, but this

remains uncertain.

At the time of this writing, there are no empirical studies directly reporting on the effects of

e-cigarette use among COVID-19 patients, although EVALI injuries have continued during the

pandemic (Armatas et al., 2020). In addition, researchers studying vape-related conversations on

social media have highlighted a great deal of uncertainty with respect to the intersection of e-cig-

arette use and COVID-19; they identified some individuals discussed whether early COVID

cases were misinterpreted as EVALI, while others alleged that vaping could actually serve as a

protective factor against COVID-19 infections, claims which are unsubstantiated (Majmundar

et al., 2020). Recent research indicates that social media use may exacerbate the spread of misin-

formation about COVID-19, and in doing so, undermine protective health behaviors (Allington

et al., 2020). As such, there remains a great deal of uncertainty regarding the relationship of

e-cigarette use to COVID-19 risks among the lay public. Yet, despite this uncertainty, e-cigarette

users have developed beliefs and attitudes about COVID-19 and the risks related to their own

e-cigarette use. For these reasons, the examination of the health beliefs of e-cigarette users during

the early stages of the COVID-19 pandemic is important, perhaps especially considering that

uncertainty due to scientific gaps in knowledge about COVID-19 remain. Such emergent beliefs

may play a role not only in behavioral responses to COVID-19, but have implications for e-cig-

arette intervention efforts as well.

Perceptions and beliefs play an important role in motivating and shaping health behaviors.

Health beliefs shape how individuals understand and pursue health and risk behaviors within the

contexts of their daily lives. As an important psychological construct, beliefs have been core

components of classic psychological theories on health behavior such as the Health Belief Model

(Rosenstock, 1974) and the Theory of Reasoned Action (Fishbein, 1979; Fishbein & Ajzen,

1975). Such theories conceptualizing the role of beliefs in health behavior have been applied to

successfully predict a wide range of health outcomes, such as condom usage, cancer screenings,

dieting, medication adherence, and substance use (Albarracin et al., 2001; Fisher et al., 1995;

Rich et al., 2015; Sainsbury & Mullan, 2011; Shim et al., 2006; Vissman et al., 2013) and

specifically for studies of nicotine consumption (Guo et al., 2007; Pepper et al., 2015) including

e-cigarette use (Coleman et al., 2016; Dobbs et al., 2019). Emergent beliefs about COVID-19 and

their relationship to e-cigarette use may similarly shape responses to the COVID-19 pandemic

among e-cigarette users, and in doing so reshape how e-cigarette users understand their con-

sumption within the context of the pandemic (Harper et al., 2020).