How Smoking & Vaping Increase COVID-19 Risk in Children

When it comes to smoking and vaping, adolescents can often develop and maintain these behaviors as a result of peer influence. With social distancing measures in effect and as families continue to self-isolate at home, many parents are now seeking out information on the correlation between smoking/vaping and COVID-19 as a way to help their children quit these habits. Jonathan Winickoff, MD, MPH, general pediatrician and researcher in tobacco control at Mass General for Children, shares what is currently known about the relationship between smoking/vaping and COVID-19 in children, including how these two habits can increase your child's risk for catching and spreading the virus.

The Effects of Smoking and Vaping on Healthy Lungs

Any time a child inhales ultra-fine smoke or vape particles, toxins and other carcinogens enter the lungs causing damage. While it is commonly known that smoking tobacco can lead to chronic health problems, the health effects of vaping—a popular form of inhaling nicotine via an e-cigarette—are not fully understood because they haven’t been around long enough to study the long-term health effects.

"We don't have all the answers about vaping," says Dr. Winickoff. "But we know that it can cause asthma and lung inflammation, and it can also damage the body's immune defenses against viruses and bacteria similar to smoking."

While a condition like asthma often takes time to develop, other effects of smoking and vaping can be more immediate:

• A weakened immune response: In both children and adults, vaping and smoking weakens the body's defenses by damaging the lung's cilia—hair-like fibers that help protect the body by expelling mucus, viruses, bacteria and other toxicants from the lungs. When they come into contact with tobacco smoke and electronic cigarette aerosol, cilia are temporarily paralyzed and, ultimately, unable to support a healthy immune response
• Allergic reactions: These reactions can occur as a result of flavorings in vaping products, which could manifest at any time, including upon initial inhalation

Short term effects from smoking and vaping can include hypersensitivity pneumonitis or vaping associated lung injury.

Increasing COVID-19 Risk

"COVID-19 patients who smoke are more than twice as likely to develop a severe infection when compared to those with no smoking history," says Dr. Winickoff. Additionally, smokers who catch COVID-19 are also more likely to be admitted into the intensive care unit, be placed on a ventilator or die from the infection.

While there's still plenty to learn about vaping's relationship to COVID-19, the information that has been presented thus far is concerning. In addition to its harmful impact on the lung's cilia, vaping affects the macrophage and neutrophil cells in the lungs that are designed to attack viruses and microbial pathogens.

Another considerable risk of both smoking and vaping is their reliance on hand-to-mouth interaction, a behavior that goes against guidelines from the Centers for Disease Control (CDC) and other public health officials on best practices to prevent COVID-19 infection.

Helping Children Quit

While the benefits of smoking cessation can start immediately upon quitting, medical professionals are still learning about how quickly benefits accrue with vaping cessation.

"We don't really know how quick the return to health is for vaping. But from what I've seen in my patients, once they stop vaping, the lungs heal relatively quickly in most cases," says Dr. Winickoff.

Parents should communicate with their child about the risks of smoking, vaping and sharing these products with other people, as well as stress the importance of frequent handwashing and social distancing.

Parents can also reach out to the child's pediatrician for recommended strategies to help their child quit smoking and vaping, like using nicotine patch nicotine gum, and other medications for those who can’t quit all at once.  These methods are even more effective when paired with expert support from the free national quit lines:

• 1-800-QUIT-NOW, call 1-800-784-8669
• SmokefreeTXT, text "QUIT" (7848) to IQUIT (47848)