Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19

J Adolesc Health. 2020 Oct;67(4):519-523. doi: 10.1016/j.jadohealth.2020.07.002. Epub 2020 Aug 11.


Purpose: This study aimed to assess whether youth cigarette and electronic cigarette (e-cigarette) use are associated with coronavirus disease 2019 (COVID-19) symptoms, testing, and diagnosis.

Methods: An online national survey of adolescents and young adults (n = 4,351) aged 13-24 years was conducted in May 2020. Multivariable logistic regression assessed relationships among COVID-19-related symptoms, testing, and diagnosis and cigarettes only, e-cigarettes only and dual use, sociodemographic factors, obesity, and complying with shelter-in-place.

Results: COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only (95% confidence interval [CI]: 1.82-13.96), seven times more likely among ever-dual-users (95% CI: 1.98-24.55), and 6.8 times more likely among past 30-day dual-users (95% CI: 2.40-19.55). Testing was nine 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). Symptoms were 4.7 times more likely among past 30-day dual-users (95% CI: 3.07-7.16).

Conclusions: COVID-19 is associated with youth use of e-cigarettes only and dual use of e-cigarettes and cigarettes, suggesting the need for screening and education.

Keywords: COVID; Communicable disease; Coronavirus; Electronic cigarette; Infectious disease; Lung; Pandemic; Smoking; Tobacco.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Betacoronavirus
  • COVID-19
  • Cigarette Smoking / adverse effects*
  • Cigarette Smoking / epidemiology
  • Coronavirus Infections / etiology*
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems
  • Female
  • Humans
  • Male
  • Pandemics
  • Pneumonia, Viral / etiology*
  • Risk Factors
  • SARS-CoV-2
  • Surveys and Questionnaires
  • Vaping / adverse effects*
  • Vaping / epidemiology
  • Young Adult