The authors identified 19 peer-reviewed papers (16 from China, 1 from Korea, and 2 from U.S.) published before April 28, 2020 on COVID-19 patients with data on smoking behavior. The analysis consisted of 11,590 COVID-19 patients, 731 (6.3%) with a history of smoking. Among the patients with a history of smoking, 29.8% experienced COVID-19 progression, compared to 17.6% non-smoking patients who experienced disease progression (OR 1.91, 95% CI 1.42-2.59). 
*"There was moderate heterogeneity among the studies (I2=38%, p=.048) and no significant evidence of publication bias (Harbord’s p=.813, Peters’ p=.941)."

Smoking Is Associated With COVID-19 Progression: A Meta-analysis

Researchers from Stanford University conducted a cross-sectional survey online of U.S. adolescents (13-24 years old) to assess if e-cigarette and cigarette usage increases the risk of being infected with COVID-19.  There were 4,351 respondents to the survey.  It was found that past 30 day dual users (use both e-cigarettes and cigarettes only within the last 30 days) were 6.8 times more likely to test positive for COVID-19.  Ever users of e-cigarettes (use only e-cigarettes) were five times more likely to test positive for COVID-19, while ever dual users (use both e-cigarettes and cigarettes) were seven times more likely to test positive for COVID-19.  


E-cigarette users and dual users are most likely at higher risk for being infected with COVID-19 because being exposed to nicotine and other chemicals within e-cigarettes has a negative effect on respiratory health, specifically on proper lung functioning.  Additionally, the act of sharing e-cigarette devices is common among adolescent e-cigarette users, serving as a potential pathway of infection from one individual to another.  Considering that e-cigarette usage is very widespread in the U.S., especially among adolescents, it can be concluded that adolescent e-cigarette usage is further exacerbating the COVID-19 pandemic.  

E-Cigarette and Cigarette Use is Associated with a Higher Risk of COVID-19

- Smoking Is Associated With COVID-19 Progression: A Meta-analysis
- E-Cigarette and Cigarette Use is Associated with a Higher Risk of COVID-19

Michigan State University

University of Michigan - Ann Arbor

Substance Use Issues Associated with the COVID-19 Pandemic by Substance

Opioid Substance Use Issues Associated with the COVID-19 Pandemic

Nicotine Substance Use Issues Associated with the COVID-19 Pandemic

- Description of Alcohol Use Disorder (AUD)
- Higher risk groups for increased alcohol consumption
- Reports/Concerns of Elevated Alcohol Drinking During the COVID-19 Pandemic
- Risks of increased alcohol use
- Suggestions to counteract substance use issues

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