Individual and Community Factors: Lessons from COVID-19 Hospitalizations

Posted on June 11, 2025 by Danika Williams

This entry is part 6 of 16 in the series July 2025

The recent study, “Smoking and Risks Contributing to COVID-19 Hospitalization in Washoe County, Nevada, 2020-2021,” analyzed more than 10,000 COVID-19 cases in Washoe County, Nevada, to better understand how individual factors, such as smoking and other demographics, along with community conditions, were associated with COVID-19 hospitalization during the first year of the pandemic.

The study used a novel approach by integrating individual-level COVID-19 case surveillance data with the US Census Bureau’s Community Resilience Estimates, which served as neighborhood-level proxies for social determinants of health data not available at the individual level. The findings help resolve conflicting evidence about smoking’s role in COVID-19 severity while demonstrating how integrating individual and community-level data can enhance understanding of health disparities and inform targeted interventions.

Key Findings

Addressed the “smoker’s paradox” by providing evidence that both current and former smokers had higher odds of being hospitalized, contradicting earlier studies suggesting protective effects of smoking in COVID-19 severity.
Identified key individual vulnerabilities and community-level factors associated with COVID-19 hospitalization, highlighting health disparities that were amplified during the pandemic and the importance of considering community context in both analyses and in preparedness.
Demonstrated a replicable framework for integrating surveillance data with the US Census Bureau’s Community Resilience Estimates to help identify high-risk populations for emergency preparedness and response.

Read Our Article in JPHMP

These findings offer practical guidance for public health preparedness. Public health agencies should implement interventions at multiple levels by targeting high-risk populations based on identified individual risk factors as well as broader community factors.

The analysis framework demonstrated in this study shows how integrating individual and community-level data can help identify vulnerable neighborhoods and guide more effective resource allocation. This multilevel approach provides a replicable model that other communities can adapt for emergency planning and response.

To learn more about our study and its findings, read “Smoking and Risks Contributing to COVID-19 Hospitalization in Washoe County, Nevada, 2020-2021” in the July 2025 volume of the Journal of Public Health Management and Practice.

Acknowledgements

This research would not have been possible without co-authors Minggen Lu, PhD; Ann M. Weber, PhD, MPH; Daniel M. Cook, PhD; Lingchen Wang, PhD, MS; and Wei Yang, PhD, MD. We gratefully acknowledge Northern Nevada Public Health and its COVID-19 surveillance team for their essential work during the pandemic.

About the Author

Danika Williams: Danika Williams, PhD, MPH, is an Epidemiologist and the Respiratory Virus Surveillance Program Coordinator for Northern Nevada Public Health. She previously led statewide preparedness and disease surveillance programs in Nevada. She is a Research Affiliate at the University of Nevada, Reno, focusing on infectious disease epidemiology and public health practice.