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Decreasing COVID-19 vaccine hesitancy is an urgent challenge in the US. This study aimed to examine COVID-19 vaccine hesitancy among U.S. adults with a history of using tobacco products or marijuana. Data were collected online in 2020-2021 including respondents' willingness to accept a COVID-19 vaccine, factors that may promote vaccine acceptance, and prior history of influenza vaccination. Logistic regression models were conducted to estimate the associations between vaccine hesitancy and demographic characteristics, substance use, the impact of the COVID-19 pandemic, and prior influenza vaccination. Among 387 respondents, 49.1% were willing to receive a COVID-19 vaccine, 26.0% were unwilling, and 24.9% were "not sure." Blacks, suburban or rural residents, those who lived by themselves or with a family with five members or above, those who were not stressed because of the COVID-19 pandemic were more likely to say "no" to a COVID-19 vaccine. Respondents who never, only once, or during some years received an influenza vaccine were 7.0, 6.2, and 5.2 times more likely to say "no" to a COVID-19 vaccine than respondents who received an influenza vaccination every year or almost every year. The use of cigarettes, e-cigarettes, and marijuana, as well as heavy drinking of alcohol, were not associated with COVID-19 hesitancy. The associations between demographic factors and vaccine hesitancy were roughly similar for COVID-19 and influenza vaccines. Although various demographic groups have different levels of vaccine hesitancy and also have different factors to increase their acceptance, addressing misinformation related to COVID-19 vaccines, particularly concern about the safety of the vaccines is crucial in general.

COVID-19 Vaccine Hesitancy and Its Determinants Among Adults with a History of Tobacco or Marijuana Use