Smoking, e-cigarette use up risk of COVID-19 in youths

Adolescents and young adults who use electronic cigarettes or both e-cigarettes and cigarettes are at greater risk of getting infected with the novel coronavirus disease (COVID-19), suggests a study.

“[O]ur investigation informs public health concerns that the ongoing youth e-cigarette epidemic contributes to the current COVID-19 pandemic,” the researchers said.

A total of 4,351 adolescents and young adults aged 13–24 years completed an online national survey in May 2020. Multivariable logistic regression was used to examine the associations of COVID-19–related symptoms, testing, and diagnosis with cigarettes only, e-cigarettes only, and dual use, as well as with sociodemographic factors, obesity, and complying with shelter-in-place.

Diagnosis of COVID-19 was five times (95 percent confidence interval [CI], 1.82–13.96) more likely among ever-users of e-cigarettes only, seven times (95 percent CI, 1.98–24.55) more likely among ever-dual users, and 6.8 times (95 percent CI, 2.40–19.55) more likely among past 30-day dual users. [J Adolesc Health 2020;doi:10.1016/j.jadohealth.2020.07.002]

Testing was nine times (95 percent CI, 5.43–15.47) and 2.6 times (95 percent CI, 1.33–4.87) more likely among past 30-day dual users and e-cigarette only users, respectively. In addition, past 30-day dual users were 4.7 times (95 percent CI, 3.07–7.16) more likely to develop COVID-19 symptoms.

Several mechanisms drive the associations of both dual use and e-cigarette use with COVID-19 infection. First, increased exposure to nicotine and other chemicals in e-cigarettes adversely affects lung function, and previous studies show that lung damage due to e-cigarette use is similar to combustible cigarettes. [Am J Respir Crit Care Med 2019;200:1392-1401; Curr Opin Pediatr 2020;32:378-383; Eur Respir J 2018;51:1701661; Am J Respir Crit Care Med 2018;197:492-501]

Secondly, repeated touching of one’s hands to the mouth and face, which is common among users of cigarettes and e-cigarettes, promotes the spread of COVID-19. Finally, sharing of devices is also a common practice among youth e-cigarette users. [Nicotine Tob Res 2020;doi:10.1093/ntr/ntaa059; J Adolesc Health 2020;67:46-52]

Some racial/ethnic groups, particularly African American, Hispanic, and multirace youth, were also found to be at higher risk for COVID-19, and this was supported by evidence of densely populated living conditions that make social distancing challenging, greater economic stress, and service-industry work environments where working from home is less feasible. [JAMA 2020;doi:10.1001/jama.2020.8598; J Racial Ethn Health Disparities 2020;7:398-402]

Furthermore, both obesity and underweight correlated with COVID-19 outcomes. Earlier studies have shown that obesity is a risk factor for COVID-19 and being underweight affects lung function. [Pediatr Pulmonol 2014;49:1003-1010; Tanaffos 2014;13:20-26; Arh Hig Rada Toksikol 2017;68:53-58; Sci Rep 2019;9:1-10; Morb Mortal Wkly Rep 2020;69:458-464]

“[These] findings have direct implications for healthcare providers to ask all youth and COVID-19–infected youth about cigarette and e-cigarette use history; for parents, schools, and community-based organizations to guide youth to learn more about how e-cigarettes and dual use affect the respiratory and immune systems; for the Food and Drug Administration to effectively regulate e-cigarettes during the COVID-19 pandemic; and for the development and dissemination of youth-focused COVID-19 prevention messaging to include e-cigarette and dual use,” the researchers said.