Young adults who smoke have double the risk of getting seriously sick with COVID-19 than do nonsmokers, according to new research from the University of California San Francisco. Fortunately for Washingtonians, relatively few of us smoke.

Smoking and vaping are risky for any age group when it comes to respiratory illnesses, including COVID-19. But they stand out as a vulnerability for people between 18 and 25 years old partly because that age group has so few other high-risk conditions for severe COVID-19, according to the study, which was published July 13 in the Journal of Adolescent Health (JAH).

“The most prevalent factor conferring medical vulnerability to severe COVID-19 illness among young adults is smoking. Notably, the risk of being medically vulnerable to severe disease is halved when smokers are removed from the sample,” wrote senior author Dr. Charles Irwin Jr. of the UCSF Division of Adolescent and Young Adult Medicine. “Efforts to reduce smoking and e-cigarette use among young adults would likely lower their vulnerability to severe disease.”

A May study by University of California San Francisco (UCSF) researchers also found that smokers and vapers — and people who used to smoke or vape —were almost twice as likely to experience negative COVID-19 outcomes as people who had never smoked.

The authors of the May article say cigarettes, cigars and e-cigarettes increase damage to upper airways and decrease pulmonary immune function. They also note that smokers are known to have a higher risk of infection and mortality from MERS-COV, a respiratory illness caused by a different coronavirus.

The UCSF studies do not address marijuana. But cannabis smoke also comes with issues for the lungs, according to Dr. Mitchell Glass, a pulmonologist and spokesperson for the American Lung Association.


“Marijuana burns at a much, much lower temperature than a commercially made cigarette. Because of that, the person is inhaling a certain amount of unburnt plant material,” which irritates the lungs in a similar way as ragweed, birch and oak pollen or other foreign particles, Dr. Glass told CNN.

The study in the JAH also said young adults are now picking up cigarettes at higher rates than adolescents, a reversal of previous initiation patterns.

But Washington adults, on the whole, don’t smoke as much as those in most other states.

At an estimated 12%, Washington state adults have the third lowest cigarette smoking rate of any state, behind Utah and California, according to data from the Centers for Disease Control and Prevention for 2018, the most recent year for which these stats are available. We’re fourth if you count Puerto Rico, where 10% of adults smoke cigarettes.

The states with the highest percentage of smokers are West Virginia, with more than a quarter of adults smoking, Kentucky with 23.4% and Arkansas with almost 23%.

Adolescents, meanwhile, seem to be reaching for e-cigarettes instead. A Healthy Youth Survey found that more than four times as many 10th graders report using vapor products than cigarettes, according to the Washington state Department of Health (DOH).


In Washington state, eighth-grade, 10th-grade and 12th-grade use of vapor products all jumped by about 50% between 2016 and 2018, the DOH wrote in a bulletin.

Whether it’s vapor or smoke, regularly inhaling something besides air into the lungs is proving to be even riskier during a pandemic involving a respiratory illness. And while a young adult’s chances of severe COVID-19 symptoms or death are generally low, the UCSF studies show the equation can change when the person is a smoker.

People younger than 40 now make up the majority of Washington state’s COVID-19 cases, with 39% in people age 20-39 (the largest share of cases for any age group) and 12% in people 19 or younger. The DOH doesn’t include in its COVID-19 data what proportion of those patients smoke.

For answers to common questions about young people and COVID-19, visit

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