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

Gallus, Silvano; Bosetti, Cristina; Gorini, Giuseppe; Stival, Chiara; Boffi, Roberto; Lugo, Alessandra; Carreras, Giulia; Veronese, Chiara; Santucci, Claudia; Pacifici, Roberta; Tinghino, Biagio; Zagà, Vincenzo; Russo, Patrizia; Cattaruzza, Maria Sofia

doi:10.2188/jea.je20220321

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…Among COVID-19 patients, current smokers are on average younger than former smokers. For example, in an Italian multicentric study based on 1406 COVID-19 patients, the mean age of current smokers was 57.7 years, that of never-smokers was 63.8 years and that of former smokers was 66.9 years, respectively [ 36 , 37 ]. Considering crude risk estimates – not adjusted, among other covariates, by age – could provide highly misleading results on the association between smoking status and COVID-19 mortality.…”

Section: Discussionmentioning

confidence: 99%

The role of smoking in COVID-19 progression: a comprehensive meta-analysis

et al. 2023

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The association between current smoking and coronavirus disease 2019 (COVID-19) progression remains uncertain. We aim to provide up-to-date evidence of the role of cigarette smoking in COVID-19 hospitalisation, severity and mortality. On 23 February 2022 we conducted an umbrella review and a traditional systematic reviewviaPubMed/Medline and Web of Science. We used random-effects meta-analyses to derive pooled odds ratios of COVID-19 outcomes for smokers in cohorts of severe acute respiratory syndrome coronavirus 2 infected individuals or COVID-19 patients. We followed the Meta-analysis of Observational Studies in Epidemiology reporting guidelines. PROSPERO: CRD42020207003. 320 publications were included. The pooled odds ratio for currentversusnever or nonsmokers was 1.08 (95% CI 0.98–1.19; 37 studies) for hospitalisation, 1.34 (95% CI 1.22–1.48; 124 studies) for severity and 1.32 (95% CI 1.20–1.45; 119 studies) for mortality. Estimates for formerversusnever-smokers were 1.16 (95% CI 1.03–1.31; 22 studies), 1.41 (95% CI: 1.25–1.59; 44 studies) and 1.46 (95% CI 1.31–1.62; 44 studies), respectively. Estimates for ever-versusnever-smokers were 1.16 (95% CI 1.05–1.27; 33 studies), 1.44 (95% CI 1.31–1.58; 110 studies) and 1.39 (95% CI 1.29–1.50; 109 studies), respectively. We found a 30–50% excess risk of COVID-19 progression for current and former smokers compared with never-smokers. Preventing serious COVID-19 outcomes, including death, seems the newest compelling argument against smoking.

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Section: Discussionmentioning

confidence: 99%

The role of smoking in COVID-19 progression: a comprehensive meta-analysis

et al. 2023

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“…Smokers' risk-taking behavior [68,71] and smokers believe that they are protected against the severe manifestation of COVID-19 infection [72] can be reflected in their lower vaccination rate. The organization of vaccination should seriously consider the special needs of this vulnerable group because it is well-known that the consequences of COVID-19 infection are more serious among smokers than among non-smokers [73].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of and Inequalities in COVID-19 Epidemic Control Strategies in Hungary: A Nationwide Cross-Sectional Study

et al. 2023

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Introduction: Before the mass vaccination, epidemiological control measures were the only means of containing the COVID-19 epidemic. Their effectiveness determined the consequences of the COVID-19 epidemic. Our study evaluated the impact of sociodemographic, lifestyle, and clinical factors on patient-reported epidemiological control measures. Methods: A nationwide representative sample of 1008 randomly selected adults were interviewed in person between 15 March and 30 May 2021. The prevalence of test-confirmed SARS-CoV-2 infection was 12.1%, of testing was 33.7%, and of contact tracing among test-confirmed infected subjects was 67.9%. The vaccination coverage was 52.4%. Results: According to the multivariable logistic regression models, the occurrence of infection was not influenced by sociodemographic and lifestyle factors or by the presence of chronic disease. Testing was more frequent among middle-aged adults (aOR = 1.53, 95% CI 1.10–2.13) and employed adults (aOR = 2.06, 95% CI 1.42–3.00), and was more frequent among adults with a higher education (aORsecondary = 1.93, 95% CI 1.20–3.13; aORtertiary = 3.19, 95% CI 1.81–5.63). Contact tracing was more frequently implemented among middle-aged (aOR41-7y = 3.33, 95% CI 1.17–9.45) and employed (aOR = 4.58, 95% CI 1.38–15.22), and those with chronic diseases (aOR = 5.92, 95% CI 1.56–22.47). Positive correlation was observed between age groups and vaccination frequency (aOR41-70y = 2.94, 95% CI 2.09–4.15; aOR71+y = 14.52, 95% CI 7.33–28.77). Higher than primary education (aORsecondary = 1.69, 95% CI 1.08–2.63; aORtertiary = 4.36, 95% CI 2.46–7.73) and the presence of a chronic disease (aOR = 2.58, 95% CI 1.75–3.80) positively impacted vaccination. Regular smoking was inversely correlated with vaccination (aOR = 0.60; 95% CI 0.44–0.83). Conclusions: The survey indicated that testing, contact tracing, and vaccination were seriously influenced by socioeconomic position; less so by chronic disease prevalence and very minimally by lifestyle. The etiological role of socioeconomic inequalities in epidemic measure implementation likely generated socioeconomic inequality in COVID-19-related complication and death rates.

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“…Furthermore, recent studies have also explored the potential involvement of nAChRs in COVID-19 severity. While the specific mechanisms and implications are still being investigated, there is emerging evidence linking nAChRs to COVID-19 pathophysiology [54,[74][75][76][77][78][79].…”

Section: Nicotinic Acetylcholine Receptors (Nachrs)mentioning

confidence: 99%

“…Smoking is a potential risk factor for COVID-19 since nicotine upregulates ACE2 expression. [74][75][76][77][78][79] Table 3. Cont.…”

Section: Covid-19mentioning

confidence: 99%

Nicotine: From Discovery to Biological Effects

Sansone,

Milani,

Fabrizi

et al. 2023

IJMS

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Nicotine, the primary psychoactive agent in tobacco leaves, has led to the widespread use of tobacco, with over one billion smokers globally. This article provides a historical overview of tobacco and discusses tobacco dependence, as well as the biological effects induced by nicotine on mammalian cells. Nicotine induces various biological effects, such as neoangiogenesis, cell division, and proliferation, and it affects neural and non-neural cells through specific pathways downstream of nicotinic receptors (nAChRs). Specific effects mediated by α7 nAChRs are highlighted. Nicotine is highly addictive and hazardous. Public health initiatives should prioritize combating smoking and its associated risks. Understanding nicotine’s complex biological effects is essential for comprehensive research and informed health policies. While potential links between nicotine and COVID-19 severity warrant further investigation, smoking remains a significant cause of morbidity and mortality globally. Effective public health strategies are vital to promote healthier lifestyles.

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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

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record.

Cited by 8 publications

References 22 publications

The role of smoking in COVID-19 progression: a comprehensive meta-analysis

The role of smoking in COVID-19 progression: a comprehensive meta-analysis

Effectiveness of and Inequalities in COVID-19 Epidemic Control Strategies in Hungary: A Nationwide Cross-Sectional Study

Nicotine: From Discovery to Biological Effects

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