Teens and young adults who vape are far more likely to be diagnosed with COVID-19 than those who don’t, a new study by Stanford researchers found. A young person who has vaped and smoked cigarettes was seven times more likely to be diagnosed with COVID-19, according to the study published today in the Journal of Adolescent Health. Someone who only vaped was five times as likely to be diagnosed.

Public health officials should be concerned about vaping as they try to get the ongoing pandemic under control and as the number of younger people testing positive grows, experts tell The Verge. Not only that, but young vapers’ vulnerability to COVID-19 should inform how regulators address the popularity of e-cigarettes, say the new paper’s authors.

“When I first started seeing the stories come out that adolescents and young adults were suddenly being diagnosed with COVID-19 and actually getting sick from it, one of the thoughts I had was, ‘wow, could this study partly explain that?’” says Bonnie Halpern-Felsher, senior author of the study.

The proportion of young people getting infected with COVID-19 has recently risen dramatically, the World Health Organization found this month. Out of the 6 million people with the disease globally for whom the WHO had data on age, the percentage of those aged 15 to 24 tripled from 4.5 percent on February 24th to 15 percent on July 12th.

Halpern-Felsher’s research doesn’t reveal exactly how vaping increases a young person’s likelihood of getting sick. It might be because of the way vaping affects the lungs or immune system — or vapers may be more exposed to COVID-19 for other reasons. People who vape tend to share devices and touch their faces more as they puff, the paper notes.

Yet, after outbreaks of vaping-associated lung injuries last year, “This is yet one more sign that e-cigarettes are unhealthy,” Halpern-Felsher says. “Look, this is a pandemic … this is the time for you to quit and not start vaping,” she says.

“I don’t think anybody will be shocked at the results. I think people [will say] we saw this coming,” says Ana María Rule, an assistant professor at Johns Hopkins’ Department of Environmental Health and Engineering, who was not involved in the study. She notes that COVID-19 and electronic cigarettes affect the same parts of the lungs.

While the results may not be surprising, it’s an important study, according to Rule. Researchers have suspected that vaping would lead to long-term health effects. “What this [study] changes, is that we’re now seeing that it actually could have short term health effects,” she says.

The new paper’s findings are based on an online survey conducted in May of 4,351 US residents between the ages of 13 and 24. The sample reflects roughly equal numbers of people of different ages, races, and genders, and the results were adjusted for confounding variables like the number of COVID-19 cases in survey participants’ states and whether participants followed shelter-in-place orders.

It’s also significant that unlike similar studies looking into links between cigarette smoking and COVID-19 outcomes, the new research is population-based. Previous research studied COVID-19 patients, whereas the new study includes more people than just those who have already tested positive. That makes it more of an unbiased sample, Halpern-Felsher explains.

The new paper calls for the Food and Drug Administration to regulate e-cigarettes and do outreach with teens on the link between vaping and COVID-19 as the pandemic continues to wreak havoc in the US. On top of that, health care providers should ask patients whether they have a history of vaping or smoking, Halpern-Felsher and her co-authors write in the paper. Ultimately, that could give doctors a better understanding of how at-risk their young patients are during the pandemic.

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