Researchers from Stanford University and the University of California recently published results of their new study in the Journal of Adolescent Health which examined whether US adolescent e-cigarette smokers were more likely to experience coronavirus disease 2019 (COVID-19)-related symptoms, be tested for, and/or diagnosed with COVID-19. Scroll through the slides below for more study details and key takeaways for primary care.
Potential important COVID-19 risk factor. As of August 14, 2020 there have been >5 million confirmed cases of COVID-19 in the US and nearly 21 million cases globally. Although adolescents are at a relatively lower risk of contracting COVID-19 vs adults, given the proportion of youth using e-cigarettes, youth e-cigarette and cigarette use may pose an important risk factor for COVID-19. Smoking has been linked with higher susceptibility to COVID-19, but currently there are no US population-based studies assessing the relationship between cigarette smoking, e-cigarette use, and COVID-19. Because of this, the study examined whether adolescent e-cigarette smokers were more likely to experience COVID-19-related symptoms, be tested for, and/or diagnosed with COVID-19.
Survey attracts young smokers, vapers. Researchers conducted a national cross-sectional online survey of US adolescents and young adults from May 6-May 14, 2020. The survey was posted on spaces such as social media and gaming sites. A total of 4351 participants completed the survey with 50.2% of participants being e-cigarette ever-users and 49.8% nonusers; 33.7% of subjects were adolescents, 41.6% were young adults, and 24.7% were adults.
Definition of COVID-19. Multivariable logistic regression was conducted to assess the association of ever-use and past 30-day use of cigarettes only, e-cigarettes only, and dual use with COVID-19. COVID-19 was defined as self-reported symptoms, testing, and positive diagnosis.
Likelihood of COVID-19 symptoms. Past 30-day dual-users were 4.7-times more likely to experience COVID-19-related symptoms. Experiencing such symptoms was 2-times more likely among black, Hispanic, other/multiracial, underweight, and obese participants; 1.8-times more likely among lesbian, gay, bisexual, transgender, and questioning youth; and 1.6-times more likely among those who did not comply with shelter-in-place orders.
Likelihood of COVID-19 testing. Ever-users of e-cigarettes only were 3.3-times, ever-dual-users were 3.6-times, and ever-users of cigarettes only were 3.9-times more likely to get COVID-19 testing. Past 30-day dual users were 9-times and past 30-day e-cigarette only users were 2.6-times more likely to get COVID-19 testing. Male, black, other/multiracial, and underweight participants were 2-3-times more likely to get tested.
Likelihood of COVID-19 diagnosis. Ever-dual-users were 7-times, ever-users of e-cigarettes only were 5-times, and past 30-day dual-users were 6.8-times more likely to be diagnosed with COVID-19. Sociodemographic factors associated with a positive COVID-19 diagnosis included being male, other/nonbinary gender, Hispanic, other/multiracial, and mother's completion of college-or-graduate level education.
Conclusions:
- Study provides timely evidence that e-cigarette and dual-use increases COVID-19 risk among US adolescents, young adults.
- Study can help inform public health concerns that ongoing youth e-cigarette epidemic contributes to COVID-19 pandemic.
- Authors noted various potential reasons for why dual use, e-cigarette use were linked with COVID-19, including heightened exposure to nicotine, other chemicals in e-cigarettes adversely affects lung function; frequent touching of one’s hands, mouth, face common among users and can increase risk of COVID-19 spread; and sharing devices being common among youth e-cigarette users.
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