Vaping a Risk Factor for COVID-19 in Teens, Young Adults

The coronavirus disease 2019 (COVID-19) pandemic began in the United States just as the CDC and FDA were tracking lung injuries associated with vaping and e-cigarettes. On Tuesday, a new study said it is the first to show that e-cigarette use, vaping, and smoking traditional cigarettes by US teenagers and young adults is associated with a greater likelihood of contracting COVID-19.

But vaping had stronger effects than combustible cigarettes on all aspects of COVID-19, from showing symptoms to getting tested to having the disease.

Researchers at the Stanford University School of Medicine published their findings in the Journal of Adolescent Health. The authors said the findings bring new urgency to efforts by policy makers, school officials, community leaders, and others to educate the public about the link between smoking and COVID-19. They also urged more regulation of the e-cigarette industry.

"The FDA should eliminate the sale and marketing of all e-cigs right now. There is too much concern over their health impact and on youth use to keep them on the market," said Bonnie Halpern-Felsher, PhD, FSAHM, a professor of pediatrics and research director in the Division of Adolescent Medicine at Stanford University, in an email to The American Journal of Managed Care®.

The findings were based on an online national survey of 4351 adolescents and young adults aged 13 to 24. The survey was conducted in May 2020 in all 50 states, the District of Columbia, and 3 US territories. The investigators recruited participants who were evenly divided between those who had used e-cigarettes and those who had never used nicotine. Different age groups, races, and genders were divided equally, and information about sociodemographic factors, obesity, and complying with shelter-in-place orders were also collected.

The researchers asked whether the participants had ever used vaping devices or combustible cigarettes, as well as whether they had vaped or smoked in the past 30 days. They were also asked if they had experienced COVID-19 symptoms, received a test for COVID-19, or received a positive diagnosis of COVID-19 after being tested.

Results showed that those who vaped were 5 to 7 times more likely to be infected than those who did not use e-cigarettes: e-cigarette-only users (95% CI, 1.82-13.96), users of both methods (95% CI, 1.98-24.55), and 6.8 times more likely among past 30-day dual-users (95% CI, 2.40-19.55).

Getting tested was 9 times more likely among past 30-day dual-users (95% CI, 5.43-15.47) and 2.6 times more likely among past 30-day e-cigarette only users (95% CI, 1.33-4.87).

Those who had smoked via either method in the past 30-days were 4.7 times more likely to show COVID-19 symptoms (95% CI, 3.07-7.16).

Halper-Felsher said pulmonologists are still seeing cases of e-cigarette, or vaping, product use-associated lung injury (EVALI), which came to light last summer after teens and young adults started showing up in emergency departments across the country with a mysterious lung illness. It was later determined, based on reports, that the products contained tetrahydrocannabinol, or THC, and vitamin E acetate.

The last report, made as COVID-19 began community transmission, said that 2807 individual were sicked by February 18, 2020. Of those, 68 people died.

The last regulatory action the FDA took on e-cigarettes came in January, but Halpern-Felsher said it does not go far enough.