COVID-19 has swept across the globe, infecting millions and resulting in hundreds of thousands of deaths. Substantial resources have been invested into understanding individual vulnerability in order to protect those at greatest risk. Age is the most often cited risk factor; 75% of US deaths have been in people over the age of 65, while younger people generally have milder symptoms. In addition to age, the Centers for Disease Control has delineated a list of health factors that increase vulnerability, most of which are chronic disorders that generally alter health status. The single most modifiable risk factor for severe COVID-19 infection is inhaled substance use through smoking or vaping.

Vaping and smoking increase young adults’ risk of COVID symptoms

A new study published in the Journal of Adolescent Health used national data to estimate the toll of smoking and vaping on COVID-19 risk for young adults. The team found that overall, nearly one in three young adults ages 18 to 25 in the US are at heightened risk, though that number falls to one in six among those who do not smoke or vape. In other words, smoking and vaping double the number of young adults in the at-risk category.

The at-risk categorization is more than a theoretical concern. Smoking and vaping both cause lung injury that threatens pulmonary reserve. Substance use can also weaken the immune system, resulting in reduced capacity to fight off infection. A recent study found that adolescents and young adults who smoke and vape were five times more likely to report COVID-19 symptoms and seven times more likely to have a diagnosis, compared to their peers. A combined analysis using data from multiple studies found that among people infected with COVID-19, those with history of smoking were twice as likely to have disease progression.

Risk-taking during adolescence could mean greater risk for COVID

During adolescence and young adulthood, developing brains are wired to seek large neurological rewards, resulting in the risk-taking that is associated with this stage of life. Most young adults enjoy good health and hearty physiologic reserve, allowing them to tolerate the insults of substance use without noticeable impact, until the cumulative effects accrue in middle adulthood — or at least that was generally assumed to be the case prior to the COVID-19 pandemic.

Unlike other risk factors for severe COVID-19 disease, smoking and vaping also inherently increase the risk of respiratory virus transmission. Smoking and vaping are often social activities for young adults. Both involve exhaling forcibly, which may propel droplets that carry viral particles further than at-rest breathing. The Canadian government recommends that people remain six feet apart and avoid sharing products, though people who get together to smoke or vape may not adhere to government guidelines. It goes without saying that both smoking and vaping are incompatible with wearing a mask. These factors combine to pose a real threat in places where young people gather — including colleges and universities. Schools would be smart to institute strict no-smoking and no-vaping rules and enforce them vigorously as part of a COVID-19 containment plan.

Younger people may be overconfident about health risks

Young people tend to overestimate their own ability to control a situation, and think of themselves as invincible; many are inclined to think that they will be able to quit smoking whenever they want to. A little extra confidence may be useful during the transition to adulthood, even if based on a faulty assessment of one’s own capabilities. But the same tendency can cause real problems in this pandemic. The idea that younger people are safe from COVID-19 is inaccurate; according to an early report from the CDC, one in five people ages 20 to 44 who become infected are hospitalized, and 2% to 4% require treatment in an intensive care unit. The best thing we can do for young people is to promote accurate information about their true risks. More than any other group, young adults who are able to quit smoking and vaping have the power to flatten their own personal risk curves.

Supporting young people who want to quit vaping and smoking

Parents and healthcare professionals have a role to play here, too. Many youth who use vaping products have seriously considered quitting, but quit attempts don’t always stick. Vaping is so new that specific treatments have not yet been rigorously tested, but there are effective treatments for nicotine use disorders. Healthcare professionals can prescribe medications that help relieve withdrawal symptoms and prevent cravings, and counselors can provide support during the process. Parents can help by encouraging their children to get help. For people who are trying to quit using nicotine, a little help can go a long way.

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