The Association of Tobacco Smoking, Second-hand Smoke, and Novel Tobacco Products With COVID-19 Severity and Mortality in Italy: Results From the COSMO-IT Study.

BACKGROUND: Despite the robust evidence of an excess risk of coronavirus disease 2019 (COVID-19) severity and mortality in ever smokers, the debate on the role of current and ex-smokers on COVID-19 progression remains open. Limited or no data are available on the link between electronic cigarette (e-cigarette), heated tobacco product (HTP) and second-hand smoke (SHS) exposure and COVID-19 progression. To fill this knowledge gap, we undertook the COvid19 and SMOking in ITaly (COSMO-IT) study. METHODS: A multi-centre longitudinal study was conducted in 2020-2021 in 24 Italian hospitals on a total of 1,820 laboratory-confirmed COVID-19 patients. We estimated multivariable odds ratios (OR) and 95% confidence intervals (CI) to quantify the association between smoking-related behaviours (ie, smoking status, e-cigarette and HTP use, and SHS exposure) and COVID-19 severity (composite outcome: intubation, intensive care unit admission and death) and mortality. RESULTS: Compared to never smokers, current smokers had an increased risk of COVID-19 mortality (OR 2.17; 95% CI, 1.06-4.41). E-cigarette use was non-significantly associated to an increased risk of COVID-19 severity (OR 1.60; 95% CI, 0.96-2.67). An increased risk of mortality was observed for exposure to SHS among non-smokers (OR 1.67; 95% CI, 1.04-2.68), the risk being particularly evident for exposures of ≥6 hours/day (OR 1.99; 95% CI, 1.15-3.44). CONCLUSION: This multicentric study from Italy shows a dismal COVID-19 progression in current smokers and, for the first time, in SHS exposed non-smokers. These data represent an additional reason to strengthen and enforce effective tobacco control measures and to support smokers in quitting.

The Negative Impact of Tobacco Smoking on Health-Related Quality of Life among Saudi Adolescents During the COVID-19 Pandemic.

OBJECTIVE: This study aimed to evaluate the impact of cigarette smoking and health-related quality of life among Saudi secondary vocational students during the COVID-19 pandemic. METHODS: A convenience sample of 328 answered a web-based self-administered questionnaire based on the Youth Risky Behavior Monitoring System (YRBSS) plus the Short Form 12 (SF-12) were included in the study. The target population included all Saudi students enrolled at the Secondary Industrial Institute in Dammam, Saudi Arabia, during December 2020 and February 2021. RESULTS: Out of the total of 328 male participants, representing a response rate of 38.59%, the highest percentage of respondents were in the first year (45.4%), the mean age of the participants was 17.73 years with a standard deviation (SD) of 1.85 years. The prevalence of current smokers, past smokers, and never smokers accounted for 30.2%, 21.3%, and 48.5%, respectively. First-year students reported relatively high levels of smoking prevalence and low physical scores of health-related quality of life (HRQoL). The overall mean of HRQoL of current smokers, past smokers, and never smokers accounted for 58.60, 58.38, and 63.66, respectively. In addition, current smokers reported a relatively low physical score of HRQoL 55.73. CONCLUSION: This is the first report to explore the impact of smoking on HRQoL of Secondary Industrial Institute students in Saudi Arabia during the COVID-19 pandemic. The results indicate that smoking has a negative impact on the quality of life of vocational students. Therefore, a health strategies plan may be developed to improve the quality of life for vocational students in Saudi Arabia. OBJECTIVE: This study aimed to evaluate the impact of cigarette smoking and health-related quality of life among Saudi secondary vocational students during the COVID-19 pandemic. METHODS: A convenience sample of 328 answered a web-based self-administered questionnaire based on the Youth Risky Behavior Monitoring System (YRBSS) plus the Short Form 12 (SF-12) were included in the study. The target population included all Saudi students enrolled at the Secondary Industrial Institute in Dammam, Saudi Arabia, during December 2020 and February 2021. RESULTS: Out of the total of 328 male participants, representing a response rate of 38.59%, the highest percentage of respondents were in the first year (45.4%), the mean age of the participants was 17.73 years with a standard deviation (SD) of 1.85 years. The prevalence of current smokers, past smokers, and never smokers accounted for 30.2%, 21.3%, and 48.5%, respectively. First-year students reported relatively high levels of smoking prevalence and low physical scores of health-related quality of life (HRQoL). The overall mean of HRQoL of current smokers, past smokers, and never smokers accounted for 58.60, 58.38, and 63.66, respectively. In addition, current smokers reported a relatively low physical score of HRQoL 55.73. CONCLUSION: This is the first report to explore the impact of smoking on HRQoL of Secondary Industrial Institute students in Saudi Arabia during the COVID-19 pandemic. The results indicate that smoking has a negative impact on the quality of life of vocational students. Therefore, a health strategies plan may be developed to improve the quality of life for vocational students in Saudi Arabia.

Tobacco smoking and severity of COVID-19: Experience from a hospital-based prospective cohort study in Lyon, France.

Information gathered so far from published studies attest the existence of a complex relationship between tobacco smoking and the severity of COVID-19. We investigated the association between smoking habits and the severity of COVID-19 in patients hospitalized in university-affiliated hospitals in Lyon, France. Baseline sociodemographic, clinical and biological characteristics of adult COVID-19 hospitalized patients presenting from the community were prospectively collected and analyzed. Tobacco exposure was documented at admission. Characteristics of patients hospitalized in medical wards to those admitted or transferred to intensive care units (ICUs) were compared using Mann-Whitney and Χ2 or Fisher's exact test. A composite endpoint including admission or transfer to ICU or death was created as a proxy for severe outcome. Adjusted odds ratio (aOR) and 95% confidence interval (95% CI) were calculated to identify variables independently associated with a severe outcome. Of the 645 patients with documented information on smoking habits, 62.6% were never-smokers, 32.1% ex-smokers, and 5.3% active smokers. Past tobacco use was independently associated with an increased risk of severe outcome (aOR: 1.71; 95% CI: 1.12-2.63), whereas a nonsignificant protective trend was found for active smoking. The results suggest that past smoking is associated with enhanced risk of progressing toward severe COVID-19 disease in hospitalized patients.

Tobacco smoking initiation among students in Samoa and health concerns.

BACKGROUND: High prevalence of tobacco smoking among young students remains a serious health concern given the positive association between smoking and NCDs. More recently, some studies also noted young smokers were more likely to get infected with COVID-19 compared to non-smokers. This study aims to assess the factors that influence smoking uptake among young students in Samoa. Findings from this study will provide valuable insight to policymakers and health authorities on policies and strategies to combat smoking among youth in Samoa and the Pacific Island Countries (PICs). METHODS: The 2017 Global Youth Tobacco Survey data of Samoa, available from the World Health Organization is used in the analysis. We use the multinominal logistic model to investigate the effects of socio-economic and demographics factors on young students' uptake of smoking in Samoa. RESULT: The main findings of this study indicate that sex, age, friendship, parental smoking, family discussion, outside influence, pocket money, and mother's education are important determinants of tobacco smoking initiation among youths in Samoa. CONCLUSION: Our findings contribute towards the evidence of the imperative health impact of friends, parents, and public smoking on students in Samoa. This warrants strategies that are effective in discouraging parents from smoking and implement measures that prevent smoking in public places. Moreover, educational efforts, particularly those that encourage more discussion at home settings on the harmful effects of smoking are strongly recommended. Parents are strongly encouraged to regularly monitor children's spending behaviour.

Mendelian randomization analysis provides causality of smoking on the expression of ACE2, a putative SARS-CoV-2 receptor.

Background: To understand a causal role of modifiable lifestyle factors in angiotensin-converting enzyme 2 (ACE2) expression (a putative severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] receptor) across 44 human tissues/organs, and in coronavirus disease 2019 (COVID-19) susceptibility and severity, we conducted a phenome-wide two-sample Mendelian randomization (MR) study. Methods: More than 500 genetic variants were used as instrumental variables to predict smoking and alcohol consumption. Inverse-variance weighted approach was adopted as the primary method to estimate a causal association, while MR-Egger regression, weighted median, and MR pleiotropy residual sum and outlier (MR-PRESSO) were performed to identify potential horizontal pleiotropy. Results: We found that genetically predicted smoking intensity significantly increased ACE2 expression in thyroid (ß=1.468, p=1.8×10-8), and increased ACE2 expression in adipose, brain, colon, and liver with nominal significance. Additionally, genetically predicted smoking initiation significantly increased the risk of COVID-19 onset (odds ratio=1.14, p=8.7×10-5). No statistically significant result was observed for alcohol consumption. Conclusions: Our work demonstrates an important role of smoking, measured by both status and intensity, in the susceptibility to COVID-19. Funding: XJ is supported by research grants from the Swedish Research Council (VR-2018-02247) and Swedish Research Council for Health, Working Life and Welfare (FORTE-2020-00884).

Smoking Is Independently Associated With an Increased Risk for COVID-19 Mortality: A Systematic Review and Meta-analysis Based on Adjusted Effect Estimates.

INTRODUCTION: Smoking can cause mucociliary clearing dysfunction and poor pulmonary immunity, leading to more severe infection. We performed this study to explore the association between smoking and mortality of coronavirus disease 2019 (COVID-19) patients utilizing a quantitative meta-analysis on the basis of adjusted effect estimates. AIMS AND METHODS: We conducted a systematic search of the online databases including PubMed, Web of Science, Scopus, and Embase. Only articles reporting adjusted effect estimates on the association between smoking and the risk of mortality among COVID-19 patients in English were included. Newcastle-Ottawa scale was fitted to assess the risk of bias. A random-effects model was applied to calculate the pooled effect with the corresponding 95% confidence interval (CI). RESULTS: A total of 73 articles with 863 313 COVID-19 patients were included in this meta-analysis. Our results indicated that smoking was significantly associated with an increased risk for death in patients with COVID-19 (pooled relative risk = 1.19, 95% CI = 1.12-1.27). Sensitivity analysis indicated that our results were stable and robust. CONCLUSIONS: Smoking was independently associated with an increased risk for mortality in COVID-19 patients. IMPLICATIONS: This present study may contribute to summarizing the association between smoking and the risk of COVID-19 mortality based on adjusted effect estimates. More detailed and complete data on smoking status should be collected to more accurately estimate the effect of smoking on COVID-19 mortality.

Tobacco Products and the Risks of SARS-CoV-2 Infection and COVID-19.

IMPLICATIONS: This commentary addresses the state of the evidence on tobacco products, nicotine, and COVID-19. The evidence of the effects of smoking on respiratory infections and the immune system in general are examined and the current understanding of tobacco products and risk for SARS-CoV-2 infection and the course of COVID-19 is addressed.

Could changes in the airborne pollutant particulate matter acting as a viral vector have exerted selective pressure to cause COVID-19 evolution?

Air pollution with particulate matter has been implicated in the incidence and the mortality due to COVID-19 infection. The levels of particulate matter have been shown to have decreased after regional and national lockdowns in a number of countries. COVID-19 possesses an elevated reproduction number (R0) due to its high transmission rate. COVID-19 genes have been found adherent to particulate matter which has been suggested as a vector for this virus' transmission. Following lockdown in China, the original viral Clade D steadily decreased mirroring the decline in particulate matter. Two months after the COVID-19 index case was reported in Wuhan early December 2019, a persistent mutation was noted at the D614 gene position of the viral spike protein establishing the Clade G variant. Clade G started to appear early in February and steadily attained predominance after lockdown in late February. It may be postulated that the changes in the source of airborne particulate matter, possibly derived from tobacco smoking (66% of Chinese males are smokers), may have contributed to the appearance of Clade G. Once the pandemic spread beyond China, in all countries affected except for Iceland, a consistent pattern arose whereby the initial viral Clade D outbreak was rapidly displaced by Clade G. It is hypothesized that changes in the source of COVID-19's vector in the form of particulate matter may have contributed to natural selection favouring Clade G. The "open orientation" of Clade G spike protein's three peptides as opposed to the "closed orientation" of the Clade D may have allowed easier adherence of the viral mutant to cells and as a corollary also to particulate matter. There may also have been differences between both viral Clades in the spike protein's hydrophobic properties. Experimental research on the hypothesis that particulate matter may potentially act as a COVID-19 vector needs to be undertaken. Besides the potential vector effect, the deleterious effects of particulate matter on respiratory immunity and cardiovascular health are well known and consequently airborne pollution in all its forms should be addressed on a global scale.

Covid-19 and the role of smoking: the protocol of the multicentric prospective study COSMO-IT (COvid19 and SMOking in ITaly).

The emergency caused by Covid-19 pandemic raised interest in studying lifestyles and comorbidities as important determinants of poor Covid-19 prognosis. Data on tobacco smoking, alcohol consumption and obesity are still limited, while no data are available on the role of e-cigarettes and heated tobacco products (HTP). To clarify the role of tobacco smoking and other lifestyle habits on COVID-19 severity and progression, we designed a longitudinal observational study titled COvid19 and SMOking in ITaly (COSMO-IT). About 30 Italian hospitals in North, Centre and South of Italy joined the study. Its main aims are: 1) to quantify the role of tobacco smoking and smoking cessation on the severity and progression of COVID-19 in hospitalized patients; 2) to compare smoking prevalence and severity of the disease in relation to smoking in hospitalized COVID-19 patients versus patients treated at home; 3) to quantify the association between other lifestyle factors, such as e-cigarette and HTP use, alcohol and obesity and the risk of unfavourable COVID-19 outcomes. Socio-demographic, lifestyle and medical history information will be gathered for around 3000 hospitalized and 700-1000 home-isolated, laboratory-confirmed, COVID-19 patients. Given the current absence of a vaccine against SARS-COV-2 and the lack of a specific treatment for -COVID-19, prevention strategies are of extreme importance. This project, designed to highly contribute to the international scientific debate on the role of avoidable lifestyle habits on COVID-19 severity, will provide valuable epidemiological data in order to support important recommendations to prevent COVID-19 incidence, progression and mortality.