The recent onset of the coronavirus pandemic (COVID-19) has raised concerns that people who smoke may be at a greater risk of harm from infection 1 given the impact of cigarettes on respiratory disease and immune function. 2 Similarly, there is concern that electronic cigarette (EC) use may increase harm from COVID-19, 1 though evidence is lacking. 3 While a systematic review concluded that cigarette smoking is likely associated with increased harm from COVID-19, 4 a meta-analysis did not. 5 However, as noted by Berlin et al., 6 the meta-analysis was limited by small sample sizes, resulting in large confidence intervals. 5 Berlin et al. describe findings from case series of smoking and COVID-19 as well as research from a prior coronavirus epidemic (MERS-CoV) that appear to support the association between smoking and adverse outcomes from COVID-19. 6 Regardless of the evidence on smoking and COVID-19, individual harm perceptions related to the virus may be inducing changes in tobacco use behavior. We recently conducted a cross-sectional webbased survey of dual tobacco cigarette (TC) and EC users to assess how past quit attempts differed between products. We also assessed changes in TC and EC use and motivation to quit due to COVID-19. We recruited participants using Amazon Mechanical Turk, a webbased crowd-sourcing service. Eligible participants were≥ 21 years of age, lived in the United States, reported current or past use of TCs and ECs containing nicotine on greater than 50% of days over a period of 30 days, and had attempted to reduce or quit ECs at some point in their life. Of the 593 who screened, 366 (61.7%) were eligible and completed the survey on April 10, 2020. Participants responded to questions regarding demographics, tobacco use, and reasons for quitting. In addition, we asked participants how concerned about COVID-19 they are for their own health, the health of others, and how much they believed their use of TCs or ECs increased their risk of harm from COVID-19 (0= Not at all to 10= Extremely). Participants also reported whether their (1) motivation to quit,(2) use, and (3) access to TCs and ECs has decreased, remained the same, or increased since learning about COVID-19. Our full questionnaire is available upon request. Analysis was conducted using SPSS (IBM Corp, Armonk, NY) and includes the 345 (94.3%) participants with past 30-day TC or EC use.

Participants had a mean age of 35.3 (standard deviation [SD]= 9.9) and were largely white (84.9%), non-Hispanic (80.6%), married (57.4%), and male (69.0%). All had a lifetime history of regular dual use. In the past 30 days, most had used both TCs and ECs (80.9%). Most reported current nondaily use (median= 15 days) of TCs (68.4%) or ECs (75.1%) while 17.7% smoked TCs daily and 19.7% used ECs daily. Participants smoked a median of eight TCs on days smoked. 25.2% smoked TCs and 30.7% used ECs within 30 minutes of waking.