Prevalence and descriptive data for all major variables of interest are provided in Table 1.
Table 1
Prevalence and descriptive statistics of cigarette, e-cigarette use, intentions to use e-cigarettes, cannabis consumption, and psychological distress.
| | | Overall (n = 314) | Female (n = 214) | Male (n = 100) |
Demographics | Age, M (SD) | | 20.49 (2.51) | 20.61 (2.74) | 20.13 (1.52) |
| Household income, Median | | 100 k/yr. – 150 k/yr. | 100 k/yr. – 150 k/yr. | 100 k/yr. – 150 k/yr. |
| Mother education level, | | | | |
| Father education level | | | | |
Cigarette use | *Current use, % | | 11.0 | 9.4a | 16.0b |
| | Never, % | 75.8 | 81.6a | 70.7b |
| | Ex-smoker, % | 9.6 | 9.0a | 13.3b |
| | Occasional smoker, % | 8.3 | 7.2a | 12.0b |
| | Everyday, % | 2.5 | 2.2a | 4.0b |
E-cigarette use | Ever use, % | | 39.2 | 39.5a | 42.7b |
| *Current use, % | | 11.0 | 7.5a | 4.5b |
| | Never | 55.7 | 59.2 | 56 |
| | Past user | 29.6 | 30.0a | 32.0b |
| | Occasional user | 2.9 | 1.8a | 6.7b |
| | Frequent user | 5.1 | 3.6a | 1.3b |
| | Daily user | 5.3 | 5.4a | 4.0b |
| 1Used to relieve anxiety, M (SD) | | 3.46 (1.4) | 3.33 (1.44) | 4.10 (1.13) |
| 2Used to deal with stress, M (SD) | | 2.08 (1.09) | 2.18 (1.14) | 1.74 (0.89) |
Intentions to use e-cigarettes | Intentions, % | No intentions to use | 77.6 | 78.4a | 74.8b |
| | No plans to use or abstain | 18.2 | 16.8a | 22.5b |
| | Plan to use e-cigarette | 3.4 | 3.7a | 2.3b |
| | Strongly want to use e-cigarette | 0.9 | 1.0a | 0.4b |
| 3Intended length of time for future use, M (SD) | | 5.19 (3.51) | 5.13 (3.50)a | 6.0 (3.83)b |
Exclusive vs. Dual use | Exclusive cigarette user, % | | 5.2 | 4.8a | 6.3b |
| Exclusive e-cig user, % | | 5.2 | 6.1a | 2.5b |
| Dual user, % | | 5.5 | 4.4a | 8.8b |
Cannabis | Past 30 Days Use, M number of days (SD) | | 9.47 (10.71) | 9.12 (10.65) | 10.48 (10.94) |
| Cannabis vaping, % | | 9.4 | 10a | 7.5b |
| Anxiety | | 3.31 (1.09) | 3.40 (1.08) | 3.04 (1.07) |
4Psychological distress, M (SD) | Depression | | 2.93 (0.96) | 2.99 (0.99) | 2.76 (0.84) |
Loneliness | | 2.93 (1.02) | 2.98 (1.04) | 2.08 (0.93) |
Stress | | 3.65 (0.88) | 3.72 (0.85) | 3.45 (0.92) |
Prevalence reported represent weighted percentages. |
Superscript letters across rows represent significant gender differences in prevalence estimates. |
*Current use represents the combined prevalence of occasional, frequent, and everyday users. |
1 Response range: 1 = Not applicable, I don’t experience nervousness, anxiety; 2 = No; 3 = Maybe; 4 = Yes, somewhat; 5 = Yes, a lot; 6 = Yes, definitely. |
2Resonse range: 1 = Not at all true; 2 = Not very true; 3 = Somewhat true; 4 = Very true. |
3Response range: 1 = 0 days, 2 = 1 to 6 days, 3 = 1 week, 4 = 2 weeks, 5 = 3 weeks, 6 = 4 weeks, 7 = 2 months, 8 = 3 months, 9 = 6 months, 10 = 1 year, 11 = More than 1 year. |
4Response range: 1 = Never; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Always |
Smoking and E-cigarette Use
Among the analytical sample of participants recruited after WHO declared COVID-19 a pandemic (n = 314), 20.4% (18.4% females, 29.3% males) reported being a current or past cigarette smoker, 11% reported being a current smoker (i.e., “occasionally” and “daily”), 39.2% (39.5% females, 42.7% males) reported having ever used an e-cigarette, 11% reported current use of e-cigarettes (i.e., “occasionally”, “frequently”, and “daily”). Chi-square analyses show that the prevalence of ever having used e-cigarettes was significantly higher than the prevalence of ever having smoked a cigarette (χ2 = 6074.0, df = 1, p < .001). A multinomial logistic regression was used to estimate the likelihood of exclusive cigarette, e-cigarette, and dual usage based on gender. Males were more likely to report current cigarette use (OR = 1.26, S.E. = .10, 95% CI = 1.03, 1.54), less likely to be current e-cigarette users (OR = 0.44, S.E. = .05, 95% CI = 0.40, 0.48), and more than twice as likely to be dual cigarette and e-cigarette users (OR = 2.27, S.E. = .09, 95% CI = 1.91, 2.70) than their female counterparts. See Table 1 for details of cigarette and e-cigarette prevalence among males and females.
Intentions to Use E-cigarettes
Over 6% of participants, regardless of smoking and e-cigarette use experience, indicated that they planned or wanted to use an e-cigarette in the future (“I plan to use an e-cigarette” = 5.5%; “I strongly want to use an e-cigarette” = 1.6%). Independent samples t-test demonstrated that females reported significantly higher intentions to use e-cigarettes (t = 2.04, df = 72140, p = .04). An ANCOVA among all current cigarette and/or e-cigarette users show that exclusive cigarette users’ intentions to use e-cigarettes (M = 1.75, SD = 0.58) were significantly lower than exclusive e-cigarette users’ (M = 2.38, SD = 0.62) and dual users’ intentions (M = 2.76, SD = 0.83), but dual users’ intentions to use e-cigarettes were not significantly different from exclusive e-cigarette users’ intentions (F (1, 3) = 10300.45, p < .001). Independent samples t-test show that males (M = 1.45, SD = 0.74) reported significantly higher intentions than females (M = 1.35, SD = 0.65) to use e-cigarettes (t = 2.04, df = 71240, p <.05).
The largest proportion of participants (16%) reported no intentions to use e-cigarettes (0 days), followed by 2 weeks and 1 year (8% each). Among all current cigarette and e-cigarette users, intended length of time for future e-cigarette use significantly differed between females (M = 5.13, SD = 3.50) and males (M = 6.0, SD = 3.83), with males reporting longer timeline intentions to use e-cigarettes (t = 3.37, df = 273.27, p = .001). ANCOVA results showed that intended length of time for future use of e-cigarettes was significantly different among exclusive cigarette smokers (M = 1.43, SD =1.05), exclusive e-cigarette users (M = 5.44, SD = 3.50), and dual users (M = 6.11, SD = 3.08), with cigarette users having the shortest intended length of use between 0 days and less than 1 week (F (2, 5) = 325.76, p < .001).
Logistic regressions were used to test associations between intentions to use e-cigarettes and current cigarette and e-cigarette use among females and males. Females were more likely to be current cigarette smokers if they reported intentions to use e-cigarettes (OR = 1.26, S.E. = 0.11, 95% CI = 1.02, 1.55), but the intended length of time for future e-cigarette use did not predict current cigarette usage (OR = 0.99, S.E. = 0.03, 95% CI = 0.94, 1.06). Conversely, intentions to use e-cigarettes did not predict current e-cigarette use (OR = 0.91, S.E. = 0.06, 95% CI = 0.80, 1.03) among females, yet the intended length of time for future e-cigarettes use predicted a higher likelihood of being a current e-cigarette user (OR = 2.87, S.E. = 0.03, 95% CI = 2.70, 3.04). Both intentions to use e-cigarettes (OR = 0.02, S.E. = 0.60, 95% CI = 0.01, 0.04) and intended length of time for future e-cigarettes use (OR = 1.76, S.E. = 0.11, 95% CI = 1.43, 2.16) predicted dual usage of cigarette and e-cigarettes among females. Among males neither type of intentions for e-cigarette use predicted current cigarette use nor e-cigarette use (p > .90).
Cannabis Use
Over 41% of participants, regardless of smoking and e-cigarette use experience, reported using cannabis in the past month for an average of 9 days (M = 9.47; SD = 10.71) and over 9% reported using e-cigarettes to consume cannabis (see Table 1). Independent samples t-test show that males reported significantly higher frequency of cannabis use in the last 30 days (t = 15.14, df = 38066, p < .001) in comparison to females. Also, males (M days consumed cannabis = 10.26, SD = 10.69) reported a significantly greater number of days consuming cannabis than females (M days consumed cannabis = 8.33, SD = 10.13; t = 15.14, df = 14158.95, p < .001). In addition to a higher likelihood of e-cigarette use among females (OR = 1.23, S.E. = .02, 95% CI = 1.17, 1.28), chi-square results indicated that a larger prevalence of females reported using e-cigarettes to consume cannabis (χ2 = 261.59, df = 1, p < .001) than males. Specifically, a logistic regression revealed that females (9.1%) were more than twice as likely to report using e-cigarettes to consume cannabis (OR = 2.03, S.E. = .04, 95% CI = 1.88, 2.18) than males (5.2%).
Over 7% of cannabis users (cannabis use in the last 30 days ≥ 1 day) reported intentions to use e-cigarettes (“I plan to use e-cigarettes” = 5.8%; “I strongly want to use e-cigarettes” = 1.9%) and 2% reported intentions for long-term future use of e-cigarettes (i.e., more than 1 year). Among the overall sample, recent cannabis users (i.e., at least 1 day of cannabis use in the last 30 days) reported significantly higher intentions to use e-cigarettes (M = 1.48, SD = 0.69; t = -18, 65, df = 15037.11, p < .001) and lower intentions for the length of time to use e-cigarettes in the future (M = 2.36, SD = 2.76; t = 8.51, df = 1286.07, p < .001) in comparison to participants who had not used cannabis recently or at all (M intentions to use e-cigarettes = 1.33, SD = 0.59; M intended length of time for future e-cigarette use = 3.35, SD = 3.81). Males who use cannabis reported significantly higher intentions to use e-cigarettes (M = 1.56, SD = 0.61) than their female counterparts (M = 1.45, SD = 0.72; t = 12.10, df = 13227.71, p < .001), but females reported longer intentions of future e-cigarette use (M = 2.63, SD = 2.91) than males (M = 1.46, SD = 1.98; t = -20.23, df = 3825.77, p < .001). MANCOVA results show that participants who use e-cigarettes to consume cannabis significantly differed in their intentions to use e-cigarettes (M = 2.40, S.E. = .04; F (4, 13408) = 1798.85, p < .001) and the intended length of time for future e-cigarette use (M = 2.82, S.E. = .05; F (4, 13408) = 1266.98, p < .001) than those who did not use cigarettes or e-cigarettes (MD = 0.74, S.E. = .01), exclusively used cigarettes (MD = 0.35, S.E. = .06), exclusively use e-cigarettes (MD = -0.25, S.E. = .02), and dual users (MD = -0.63, S.E. = .04; see Table 1 for descriptive data of intentions variables across groups).
Among females, linear regressions revealed that intentions to use e-cigarettes (β = 0.44, S.E. = 0.19, p < .001) and intended length of time for future e-cigarette use (β = 0.19, S.E. = 0.05, p < .001) predicted recent cannabis use (i.e., the last 30 days). Logistic regression indicated that intentions to use e-cigarettes predicted using e-cigarettes to consume cannabis (OR = 2.09, S.E. = .04, 95% CI = 0.96, 1.01), but intended length of time for future e-cigarette use did not predict using e-cigarettes to consume cannabis (p = .23). Among males, linear regressions revealed that intentions to use e-cigarettes (β = 0.35, S.E. = 0.39, p < .001) and intended length of time for future e-cigarette use (β = -0.50, S.E. = 0.09, p < .001) predicted recent cannabis use. Also, a logistic regression demonstrated that intentions to use e-cigarettes (OR = 5006.81, S.E. = 0.58, 95% CI = 1590.28, 15763.30) and intended length of time for future e-cigarette use (OR = 0.20, S.E. = 0.15, 95% CI = 0.15, 0.27) predicted the use of e-cigarettes to consume cannabis.
Psychological Distress
Over 90% of the total sample reported experiencing some level (i.e., “rarely”, “sometimes”, “often”, or “always”) of one or more type of psychological distress (i.e., anxiety, depression, loneliness, or stress). The highest frequency reported was for stress with 30% of participants reporting “sometimes”, 44% of participants reporting “often” and 15% “always”.
A paired samples t-test was used to compare levels of psychological distress. Among the overall sample, frequency of reported anxiety (M = 3.31, SD = 1.08) was significantly higher than frequency of depression symptoms (M = 2.94, SD = 0.96) in the last 30 days (t = 111.56, df = 71337, p <.001). Anxiety (M = 3.31, SD = 1.09) was significantly higher than loneliness (M = 2.93, SD = 1.02; t = 97.26, df = 71605, p < .001). Stress (M = 3.65, SD = 0.88) was significantly higher than anxiety (M = 3.31, SD = 1.09; t = -106.66, df = 71873, p < .001), depression (M = 2.94, SD = 0.96; t = -224.99, df = 71337, p <.001), and loneliness (M = 2.93, SD = 1.01; t = ̶ 202.58, df = 71605, p < .001). Depression (M = 2.94, SD = 0.96) and loneliness (M = 2.93, SD = 1.01) were not significantly different from one another (t = 1.36, df = 71609, p = .17). An ANOVA was used to assess differences in psychological distress between cigarette smokers, e-cigarette users, dual users, and cannabis vapers to individuals who did not engage in any of the behaviors. Participants who did not engage in any of the smoking or vaping behaviors reported significantly lower anxiety (M = 3.29, SD = 1.08; F(1,71873) = 447.74, p < .001), depression (M = 2.91, SD = 0.96; F(1,71605) = 631.13, p < .001), loneliness (M = 2.91, SD = 1.00; F (1, 71605) = 260.26, p < .001), and stress (M = 3.65, SD = 0.88; F (1, 71873) = 40.67, p < .001) than cigarette smokers (M anxiety = 3.40, SD = 0.92; M depression = 3.10, SD = 0.70; M loneliness = 2.90, SD = 1.05; M stress = 3.70, SD = 0.78), e-cigarette users (M anxiety = 3.86, SD = 1.13; M depression = 3.43, SD = 0.82; M loneliness = 3.36, SD = 1.11; M stress = 3.86, SD = 0.83), cannabis vapers (M anxiety = 3.31, SD = 1.02; M depression = 3.07, SD = 0.79; M loneliness = 2.85, SD = 1.14; M stress = 3.64, SD = 0.94), and dual cigarette and e-cigarette users (M anxiety = 3.53, SD = 0.89; M depression = 3.20, SD = 0.75; M loneliness = 3.13, SD = 0.96; M stress = 3.53, SD = 0.72).
Independent samples t-test was used to determine if female and male participants significantly differed in levels of psychological distress during the start of the pandemic. Results demonstrate that females reported significantly higher levels of anxiety (t = -38.349, df = 71872, p < .001), depression (t = -30.58, df = 71604, p < .001), loneliness (t = -23.18, df = 71604, p < .001), and stress (t = -35.88, df = 71872, p < .001) than males.
Logistic regressions were used to examine whether anxiety, depression, loneliness, and stress predict current cigarette use, e-cigarette use, dual usage of cigarette and e-cigarettes, as well as e-cigarettes to consume cannabis. Among females, anxiety (OR = 1.22, S.E. = 0.06, 95% CI = 1.09, 1.36), depression (OR = 1.32, S.E. = 0.06, 95% CI = 1.16, 1.49), loneliness (OR = 1.22, S.E. = 0.05, 95% CI = 1.10, 1.36) and stress (OR = 0.61, S.E. = 0.06, 95% CI = 0.54, 0.69) were significant predictors of current cigarette smoking. Anxiety (OR = 1.52, S.E. = 0.02, 95% CI = 1.45, 1.59), depression (OR = 1.46, S.E. = 0.0395% CI = 1.38, 1.54), loneliness (B = 0.87, S.E. = 0.02, 95% CI = 0.83, 0.91), and stress (OR = 0.64, S.E. = 0.03, 95% CI = 0.61, 0.68) were predictors of e-cigarette use. None of the psychological distress variables significantly predicted dual usage of cigarettes and e-cigarettes among females (p > .05). Anxiety (OR = 1.05, S.E. = 0.02, 95% CI = 1.01, 1.09), depression (OR = 1.92, S.E. = 0.03, 95% CI = 1.83, 2.02), loneliness (OR = 0.68, S.E. = 0.02, 95% CI = 0.65, 0.71) and stress (OR = 0.66, S.E. = 0.02, 95% CI = 0.63, 0.69) were significant predictors of using e-cigarettes to consume cannabis.
Among males, anxiety (OR = 1.41, S.E. = 0.08, 95% CI = 1.21, 1.64), depression (OR = 1.34, S.E. = 0.08, 95% CI = 1.14, 1.57), loneliness (OR = 1.26, S.E. = 0.06, 95% CI = 1.11, 1.42) and stress (OR = 0.76, S.E. = 0.09, 95% CI = 0.65, 0.91) were significant predictors of current cigarette smoking. Depression (OR = 3.05, S.E. = 0.07, 95% CI = 2.67, 3.48), loneliness (OR = 2.49, S.E. = 0.07, 95% CI = 2.19, 2.83) and stress (OR = 1.27, S.E. = 0.08, 95% CI = 1.10, 1.47) were significant predictors of current e-cigarette use. None of the psychological distress variables predicted dual usage among males. Anxiety (OR = 0.45, S.E. = 0.05, 95% CI = 0.40, 0.49), loneliness (OR = 0.90, S.E. = 0.05, 95% CI = 0.82, 0.99) and stress (OR = 5.46, S.E. = 0.06, 95% CI = 4.82, 6.17) were significant predictors of using e-cigarettes to consume cannabis.
Independent samples t-test was used to examine gender differences in the use of e-cigarettes to relieve anxiety and stress. Endorsement of using e-cigarettes to relieve anxiety was significantly higher among males (M = 4.10, SD = 1.13) than females (M = 3.33, SD = 1.44; t = 39.26, df = 11578.63, p < .001). Conversely, endorsement of using e-cigarettes to deal with stress was higher among females (M = 2.18, SD = 1.14) than males (M = 1.74; SD = 0.89; t = -29.51, df = 11690.20, p < .001).
Psychological Distress and Intentions to Use E-cigarettes
Linear regressions were used to test whether psychological distress predicted intentions to use e-cigarettes. Among females, anxiety (β = 0.07, S.E. = 0.01, p < .001), depression (β = 0.11, S.E. = 0.01, p < .001), loneliness (β = -0.20, S.E. = 0.01, p < .001), and stress (β = 0.04, S.E. = 0.01, p < .001) predicted intentions to use e-cigarettes. Also, anxiety (β = -0.10, S.E. = 0.03, p < .001), depression (β = 0.09, S.E. = 0.04, p < .001), loneliness (β = -0.24, S.E. = 0.04, p < .001), and stress (β = -0.10, S.E. = 0.04, p < .001) predicted intended length of time for future e-cigarette use. Among males, anxiety (β = -0.17, S.E. = 0.01, p < .001), depression (β = 0.10, S.E. = 0.01, p < .001), loneliness (β = 0.04, S.E. = 0.01, p < .001), and stress (β = 0.18, S.E. = 0.01, p < .001) predicted intentions to use e-cigarettes. Anxiety (β = 0.64, S.E. = 0.10, p < .001), depression (β = -0.46, S.E. = 0.08, p < .001), loneliness (β = 0.68, S.E. = 0.08, p < .001), and stress (β = -0.74, S.E. = 0.08, p < .001) predicted intended length of time for e-cigarette use.
Subsequently, interactions between intentions to use e-cigarettes and psychological distress factors were used to predict smoking and vaping behaviors. Among females, interactions between intentions to use e-cigarettes and anxiety (OR = 1.08, S.E. = 0.04, 95% CI = 1.00, 1.16) significantly predicted current cigarette smoking. Interactions between intentions to use e-cigarettes and anxiety (OR = 1.30, S.E. = 0.01, 95% CI = 1.26, 1.33) and depression (OR = 1.12, S.E. = 0.01, 95% CI = 1.09, 1.15) significantly predicted e-cigarette use. Interactions between intentions to use e-cigarettes and anxiety (OR = 1.06, S.E. = 0.01, 95% CI = 1.04, 1.09) and depression (OR = 1.07, S.E. = 0.01, 95% CI = 1.04, 1.10) significantly predicted using e-cigarettes to consume cannabis. Interactions with length of time for future intentions to use e-cigarettes with anxiety (OR = 2.09, S.E. = 0.09, 95% CI = 1.74, 2.51), depression (OR = 0.83, S.E. = 0.03, 95% CI = 0.78, 0.87), and loneliness (OR = 0.79, S.E. = 0.05, 95% CI = 0.73, 0.87) significantly predicted cigarette use. Interactions with length of time for future intentions to use e-cigarettes with anxiety (OR = 0.65, S.E. = 0.04, 95% CI = 0.60, 0.70), depression (OR = 1.33, S.E. = 0.02, 95% CI = 1.28, 1.38), and loneliness (OR = 1.25, S.E. = 0.03, 95% CI = 1.18, 1.32) significantly predicted e-cigarette use. Interactions with length of time for future intentions to use e-cigarettes with anxiety (OR = 1.72, S.E. = 0.03, 95% CI = 1.61, 1.83) and loneliness (OR = 0.84, S.E. = 0.02, 95% CI = 0.81, 0.86) significantly predicted e-cigarettes to consume cannabis.
Among males, no psychological distress variables significantly interacted with intentions to use e-cigarettes to predict cigarette smoking. Interactions between intentions to use e-cigarettes and anxiety (OR = 1.45, S.E. = 0.17, 95% CI = 1.04, 2.03) and depression (OR = 0.77, S.E. = 0.11, 95% CI = 0.62, 0.96) significantly predicted current e-cigarette use. Anxiety (OR = 0.61, S.E. = 0.03, 95% CI = 0.57, 0.65), and depression (OR = 5.33, S.E. = 0.06, 95% CI = 4.74, 6.0) interactions with intentions to use e-cigarettes significantly predicted using e-cigarettes to consume cannabis. Interactions between intended length of time for future e-cigarette use and anxiety (OR = 0.14, S.E. = 0.18, 95% CI = 0.10, 0.19), depression (OR = 3.74, S.E. = 0.16, 95% CI = 2.74, 5.1), and loneliness (OR = 0.37, S.E. = 0.09, 95% CI = 0.31, 0.44) to predict current cigarette use. No interactions between psychological distress factors and intended length of time for future e-cigarette use predicted e-cigarette use. Depression (OR = 0.15, S.E. = 0.55, 95% CI = 0.05, 0.45) significantly interacted with intended length of time for future e-cigarette use in predicting e-cigarette use to consume cannabis.