Vaping and smoking habits are more common among children with asthma who are most susceptible to their harmful health effects, state health research has found.

The findings might seem contradictory on the surface, because children with breathing problems might seem like the last to take up smoking, but Minnesota Department of Health experts said Tuesday that they confirm a socioeconomic picture of both asthma and smoking being more commonplace in low-income homes and conspiring to harm child health.

“Any use of tobacco, including e-cigarettes and vapes, is harmful, but youth with asthma who smoke or vape are likely to experience more intense symptoms and need more medical care,” said Dr. Courtney Jordan Baechler, an assistant commissioner for the Minnesota Department of Health.

As is true among all children and teens, those who suffer asthma are now more likely to vape or use e-cigarettes compared to other types of tobacco products, according to the research, which reviewed responses to the 2017 Minnesota Youth Tobacco Survey.

While 24% of surveyed high school students use some form of tobacco, that rate increases to nearly 30% among students with asthma. Similarly, 18% of all high school students reported being current users of e-cigarettes. That number jumped to more than 22% among students with asthma.

Asthma risks are higher for children in low-income families, partly due to the poorer quality of housing that can create dust, mold and other breathing irritants. But higher smoking rates in low-income households has also been part of the problem.

Researchers wanted to know if that combination of smoking and asthma has persisted as smoking of traditional cigarettes has declined but usage of e-cigarettes has soared.

“We were curious if we might find the same trends,” said Kathleen Norlien, a researcher in the state health department’s asthma program.

Public health officials have tried to combat the perception among teens that vaping is safer because it doesn’t produce the same type of smoke as cigarettes. Vaping products are unregulated and can contain harmful chemicals and produce small particles that are just as irritating to teens with asthma as the particles produced by cigarettes, Norlien said.

The state last week issued a public health alert after four teens suffered severe lung injuries that required hospitalizations. All of the teens had used e-cigarettes or vaping, though it was unclear if any or all of them had been using nicotine-based products or marijuana.

Health officials said that the new survey findings should alert doctors to the association between vaping, asthma and socioeconomic status, and motivate them to ask their teen asthma patients about any smoking activities.