Associations between vaping and COVID-19: cross-sectional findings from the HEBECO study

Even though tobacco smoking is harmful to the lungs, some research suggests that smokers may be at reduced risk of the coronavirus disease 2019 (COVID-19) infection. COVID-19 primarily attacks the human respiratory system, causing mild to severe illness and death.



While using e-cigarettes, or vaping, is not harmless to lung function, based on various studies it appears that the COVID-19 pandemic may have affected rates of vaping. So far there are contradictory observations; changes in vaping due to COVID-19 are inconclusive.

E-cigarettes deliver nicotine without many of the harmful toxicants and carcinogens found in cigarette smoke. The association between vaping and COVID-19 infection may help delineate some of the proposed mechanisms for any potential protective or harmful effects of nicotine on COVID-19 outcomes. Also, understanding the impact of COVID-19 on vaping rates can help identify targets for intervention during future periods of social distancing and lockdown measures.

In this context, in a recent medRxiv* preprint publication, Dimitra Kale et al. explore the associations between vaping and self-reported diagnosed/suspected COVID-19.

In this study, the research team from the University College London, UK, highlight: 1) there is no difference found in diagnosed/suspected COVID-19 in between never, current, and ex-vapers; 2) half of the current vapers changed their vaping consumption since COVID-19; 3) motivation to quit vaping was partly related to COVID-19.

The researchers found that 17.4% of recent ex-vapers had quit vaping because of COVID-19, while 40.7% of recent ex-vapers were considering taking up vaping again since COVID-19, mostly out of boredom.

The study design involved analysis of cross-sectional data (from the baseline wave) of an ongoing longitudinal online study of UK adults: the HEalth BEhaviour during the COVID-19 pandemic (HEBECO) study. HEBECO study data were collected and managed using REDCap electronic data capture tools that are hosted at University College London. The analysis plan is available here.

The study involved 2791 UK-based adults, aged 18 and over, who completed the baseline survey of the HEBECO study between 30th April 2020 and 14th June 2020. This period covers the first national lockdown in the UK to mitigate the COVID-19 infection spread. Of the whole analytic sample (2792 participants), three quarters were never smokers and the rest were current or ex-vapers.

The participants were recruited online and through several channels including paid and unpaid advertisements on social media (including vaping forums) and relevant mailing lists.

The participants self-reported their data on sociodemographic characteristics, diagnosed/suspected COVID-19, vaping status, changes in vaping, and motivation to quit vaping since COVID-19. The paper discusses in detail the questions given to the participants for assessment.

Among current vapers, while 50% of them did not change their vaping consumption since COVID-19, 40% reported an increase in vaping and 10% reported a decrease in vaping.

It is also observed that vaping is less when associated with being female, not living with children, and concurrent smoking. And vaping is more when associated with being younger, living alone, and diagnosed/suspected COVID-19.

Due to COVID-19, vapers were motivated to quit. However, the researchers also found that nearly half of recent ex-vapers were considering taking up vaping again. Most of the common reasons for taking up vaping were ‘struggling with cravings’ and ‘feeling stressed’ - they were non-COVID-19 related reasons.

In addition, this study supports that COVID-19 may have contributed to reinforcing different behavioral patterns - a proportion of people stopping completely since COVID-19, and others vaping more. The researchers also discuss the limitations of the study in detail.

The findings in this study suggest that vapers who believe they have/had COVID-19 started vaping more because of stress or believing that nicotine is protective against COVID-19.

The participants may also have misinterpreted their symptoms as many other respiratory infections share symptoms with COVID-19. This study does not address whether nicotine may be a protection against COVID-19 infection.

This is an important study in real-time investigating the differences in diagnosed/suspected COVID-19 between vapers, ex-vapers, and never vapers, after adjustment for sociodemographic characteristics, smoking status, and health conditions. It also reports changes in vaping during the COVID-19 pandemic and factors associated with these changes.

In conclusion, the study found that the diagnosed/suspected COVID-19 is not associated with vaping status, when assessed by self-report in a UK population sample.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Associations between vaping and Covid-19: cross-sectional findings from the HEBECO study; Dimitra Kale, Aleksandra Herbec, Olga Perski, Sarah E Jackson, Jamie Brown, Lion Shahab medRxiv 2020.12.01.20241760; doi:
Dr. Ramya Dwivedi

Written by

Dr. Ramya Dwivedi

Ramya has a Ph.D. in Biotechnology from the National Chemical Laboratories (CSIR-NCL), in Pune. Her work consisted of functionalizing nanoparticles with different molecules of biological interest, studying the reaction system and establishing useful applications.


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