COVID-19 Disease and Chronic Health Outcomes Associated with Nicotine Use in a Great Plains Tribal Community: A Community-Based Study

Background: The Cheyenne River Sioux Tribe (CRST) is affected by high nicotine use and disease burden. Understanding nicotine exposure is important to recognize what groups may be at higher risk for negative health outcomes, including COVID-19.

Objective: To compare self-reported health outcomes and nicotine use between exclusive electronic cigarette (e-cig) users, users of combustible cigarettes, dual e-cig/cigarette users, and nonusers among adult residents on the CRST.

Methods: The CRST "COVID-19 - Wayakta He study" ("Are you on guard against COVID-19?") recruited 562 participants on the reservation who filled out a 97-item survey. Regression models were used to analyze nicotine exposure, demographic characteristics, and health outcomes.

Results: Prevalence of nicotine use among participants was 53%. Reported median puffs per day was 15 for e-cig, 100 for cigarette, and 20 for dual users (p < 0.001). The odds of having COVID-19 were lower for nicotine users compared to nonusers (p < 0.001). The odds of hypertension (p = 0.04) and high cholesterol (p = 0.03) were lower for nicotine users compared to nonusers. The proportional odds were higher for nicotine users for longer COVID-19 recovery time (p = 0.046) and lower for more severe COVID-19 infection (p = 0.001).

Significance: This study provides critical data on self-reported COVID-19, chronic disease outcomes, and exposure to commercial nicotine products. Results from this unique Tribal community-driven study with a large sample size (N = 562 participants from 289 households) will help understand the role that environmental exposures played on increased COVID-19 mortality, help target public health interventions, and inform Tribal public health policies on emergency preparedness and exposure analyses.