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Smokers, vapers in special danger from coronavirus.

BY BRINKWIRE ON APRIL 21, 2020

—Smokers and vapers who get COVID-19 are more likely to have complications, so this might be a good time to quit, the Society of Thoracic Surgeons says.

An early study from China looked at 78 hospitalized COVID-19 patients. Researchers found those with a history of smoking had 14 times the risk of needing a higher level care, requiring a ventilator, and/or dying.

COVID-19 death rates in China are higher in men than in women, and higher smoking rates in men in that country may be a reason why.

“As COVID-19 is a virus that primarily attacks the lungs, anything that harms the lungs can weaken patients and result in more severe effects if people do become infected. It is well-known that smoking results in worse outcomes in people with pneumonia or influenza, and we are learning that smoking can pose significant risks in those with COVID-19,” thoracic surgeon Dr. Matthew Steliga wrote in a patient guide from the society.

He pointed out that smoking thickens the mucus lining people’s airways, making it harder to clear away inhaled fungi, bacteria and viruses.

“This leads to more particles and infectious agents trapped in the lungs and more difficulty in clearing out this material,” wrote Steliga, who practices at the University of Arkansas for Medical Sciences. “Those who smoke have a greater chance of getting respiratory infections, and when one does have an infection, it is harder to recover from it. Even an occasional cigarette or secondhand smoke has been linked to increased risks from acute respiratory distress syndrome.”

And, he warned, electronic cigarettes aren’t any safer than traditional cigarettes.

They can suppress immune function, and some research suggests that vaping impairs mucus clearance and the body’s ability to fight infection, Steliga said.

“We do not have clear long-term data about e-cigarette use and COVID-19, but it is agreed that the best way to avoid complications from COVID-19 is to keep your lungs as clean and healthy as possible,” he said in a society news release.

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Asking for Identification and Retail Tobacco Sales to Minors

Arnold H. LevinsonJoseph G.L. LeeLeonard A. Jason and Joseph R. DiFranza

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Abstract

BACKGROUND AND OBJECTIVES: A previous single-county study found that retail stores usually asked young-looking tobacco customers to show proof-of-age identification, but a large proportion of illegal tobacco sales to minors occurred after the customers had shown identification proving they were too young to purchase tobacco. We sought to investigate these findings on a larger scale.

METHODS: We obtained state reports for federal fiscal years 2017 and 2018 from a federal agency that tracks tobacco sales to supervised minors conducting compliance checks in retail stores. We used descriptive and multivariable logistic regression methods to determine (1) how often stores in 17 states requested identifications, (2) what proportion of violations occurred after identification requests, and (3) if violation rates differed when minors were required versus forbidden to carry identification.

RESULTS: Stores asked minors for identification in 79.6% (95% confidence interval: 79.3%–80.8%) of compliance checks (N = 17 276). Violations after identification requests constituted 22.8% (95% confidence interval: 20.0%–25.6%; interstate range, 1.7%–66.2%) of all violations and were nearly 3 times as likely when minors were required to carry identification in compliance checks. Violations were 42% more likely when minors asked for a vaping product versus cigarettes.

CONCLUSIONS: Stores that sell tobacco to underage customers are more likely to be detected and penalized when youth inspectors carry identification during undercover tobacco sales compliance checks. The new age-21 tobacco sales requirement presents an opportunity to require identifications be carried and address other long-standing weaknesses in compliance-check protocols to help combat the current adolescent vaping epidemic.

 

Accepted February 10, 2020.

Copyright © 2020 by the American Academy of Pediatrics

 

 

Philip Morris Money Is Funding Pro-Vaping Virus Spin

By Tiffany Kary

Corrected April 21, 2020, 6:43 PM EDT 

  • Groups backed by cigarette maker, Juul dispute health warnings
  • FDA says vaping has unknown effects on risks of the virus

New York City Mayor Bill de Blasio pointed a finger at the vaping industry last month as he discussed a 22-year-old New Yorker who’d been hospitalized with Covid-19. “We do think the fact that he is a vaper is affecting this situation,” de Blasio said.

The suggestion that vaping and cigarettes can worsen the risks from the new coronavirus has put nicotine purveyors in the spotlight. Groups indirectly funded by Philip Morris International, maker of Marlboros and electronic nicotine devices, and vape firm Juul Labs Inc. are pushing back. Their messages contradict public-health experts’ warnings that smoking puts people at higher risk for severe cases of Covid-19 and that vaping’s effect is unknown but potentially harmful too.

Two days after de Blasio’s statement, The Global State of Tobacco Harm Reduction, a group that maps e-cigarette use around the world, dismissed “unfounded rumors” about connections between vaping and coronavirus — and the “limited available evidence” linking it to smoking. A website called Consumer Advocates for Smoke-Free Alternatives Association published an article by Roberto Sussman and Carmen Escrig saying the “pandemic provides fertile ground for spreading misinformation on vaping.” The posts were among nine instances reviewed by Bloomberg.

Such spin can take a dangerous toll, not just on public health but now on the global economy as well, said Michél Legendre, a campaign director at the nonprofit Corporate Accountability, a frequent critic of Philip Morris and other large companies.

“We’re in the middle of a pandemic where information and time is at a premium,” Legendre said. “Having doctors and public officials have to sort through this mess of misinformation is time that most people around the world cannot afford.”

The coronavirus debate comes as companies approach a regulatory deadline to show the Food and Drug Administration that their e-cigarette products have a public-health benefit, a step that will allow the firms to keep selling them in the U.S. A judge has said he intends to extend the May deadline because of the virus.

Public-health officials and research scientists acknowledge that study of the coronavirus is still in its infancy. So is vaping, at least compared to smoking. But many say that existing evidence from diseases like tuberculosis, bronchitis and pneumonia is strong enough for them to make recommendations to the public. Anything that makes the lungs less healthy, they say, will weaken your chances against a deadly respiratory disease like Covid-19.

The FDA says smoking can result in “worse outcomes” for people with Covid-19 because it increases the risk of respiratory infections, for instance, and e-cigarette use can expose the lungs to toxic chemicals, with unknown effects for people who get the virus. The Cleveland Clinic has said “aldehydes and other components in vaping liquids can impair the immune function of cells found in the airway and lungs.” And the Canadian Pediatric Association says vaping or smoking, including cannabis, may put young people at increased risk of severe coronavirus infection.

Many messages dismissing links between the virus and vaping or smoking came from authors, scientists or publications that have received indirect funding from companies that sell cigarettes or vape devices. Often the funding behind these messages is indirect and traces back to Philip Morris International’s non-profit Foundation for a Smoke Free World, or FSFW.

While Philip Morris is best known for Marlboro cigarettes, it has said for years that it wants to move smokers to “reduced risk” products, such as its IQOS, a heat-not-burn device that already has FDA authorization, or Mesh, a vape device. Philip Morris’s sister company, Altria Group Inc., sells IQOS in the U.S. and has a stake in Juul. Asked about any links between its products and susceptibility to the virus, Philip Morris deferred to public-health bodies.

“People should continue to be guided by the advice and recommendations of their governmental health authorities and medical professionals on these complex health questions,” Philip Morris spokesman Corey Henry said in an email. The company isn’t aware of any scientific studies about smoke-free alternatives and Covid-19, he said. Altria said it’s making no claims about the relative risks of IQOS. Juul declined to comment on whether vaping carries less of a risk factor for coronavirus than smoking.

When asked about messages from groups funded by its foundation, Philip Morris said the FSFW makes its own decisions and that the $160 million the company gave to the non-profit in 2018 and 2019 had no strings attached. Derek Yach, founder of FSFW, said the groups his organization funds have their own views and that the foundation is “agnostic to the results of the research” it supports. He said he thinks it’s too soon to determine how vaping might affect coronavirus infections but he expects data will eventually show smoking does affect the severity of the disease.

Groups funded by FSFW also acknowledge that data is sparse, but reiterate a common message: Vaping is a better choice than cigarettes when it comes to concerns about the health effects of the coronavirus. Both Global State, which slammed the “unfounded rumors” tying vaping and Covid-19, and Consumer Advocates, which published the article decrying “misinformation” on the topic, received money from the foundation in 2018.

The two authors of the Consumer Advocates article, Sussman and Escrig, are affiliated with separate institutions that are members of INNCO, a group that received grants in 2018 from the FSFW with the mandate to help nicotine consumer organizations, and which has lobbied the World Health Organization on their behalf. INNCO’s members are all “independent and autonomous,” said president Julie Woessner.

Sussman, a director at ProVapeo Mexico, said INNCO has not given it funding or any other form of support such as services. Escrig, who’s listed as the international coordinator for a group called Medical Organizations Supporting Vaping and E-cigarettes, said the group “has never received financing or support of any kind” from INNCO.

The messages cited the work of a scientist, Konstantinos Farsalinos. The day after de Blasio’s comments in New York were reported, Farsalinos’s blog in Greece slammed the mayor, contending there’s “zero evidence on how e-cigarette use affects coronavirus infectivity and disease progression.” Farsalinos, a researcher at two universities in Greece and one in Saudi Arabia, belittled the original data out of China that led to the theory smoking helps the disease progress, calling it “too weak” because of the low number of smokers studied.

He suggested that vaping might be beneficial for coronavirus because a common ingredient in vape liquid, propylene glycol, has antiviral properties. This idea was also quickly picked up by other blogs and tweets.

Farsalinos said he takes no money from companies affiliated with the e-cigarette or tobacco industries: “I have no links with any foundation [including the FSFW] and I do not work for, cooperate with or have any financial or other interest in any industry or commercial entity.” When asked about past disclosures that a group called E-Cigarette Research Advocates Group has funded some of his work, he said in an email exchange that the group is a “non-official (not listed or registered anywhere) group of vapers (not businessmen) who created the website.”

Vape Illnesses

Concerns about vaping’s health effects have increased in just the last year. A spate of vape-related lung illnesses in 2019 that killed 68 people in the U.S. changed the view of how e-cigarettes can affect the respiratory system, said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “If you had asked me a year ago, I would have said combustible tobacco was worse than vaping for this kind of virus,” she said in an interview. Now, in the wake of last year’s lung illnesses, “I don’t think we know.”

Some scientists say that smoking and vaping could also make people more susceptible to infection in the first place. Dr. Stanton Glantz, a professor at the University of California, San Francisco’s Center for Tobacco Control Research and Education, said the cells that line the nose and upper airways are edged with microscopic hair-like tendrils called cilia that can push tiny viruses out. “Smoking destroys cilia,” he said. “So the ability to push this stuff out before it gets to the lungs’ alveoli is ruined if you smoke.”

The messages published by groups funded by Philip Morris or the vape industry portray such ideas as engendering mass panic – all while subtly positioning next-generation products as a better alternative to smoking for coronavirus risk.

‘Exploiting’ Tragedy

On March 10, an online magazine called Filter published an article saying smoking hasn’t definitively been linked to exacerbating Covid-19, but that there could be a benefit to switching to “risk-reduced nicotine products” like vapes. It cited Marewa Glover, a behavioral health scientist in New Zealand, saying that public-health warnings about vaping and the virus are “typical tobacco control exploiting what is a tragic unexpected outbreak.”

Filter disclosed that the article’s author, Michael McGrady, is supported by the Knowledge-Action-Change Tobacco Harm Reduction Scholarship program, which it called an independently administered scholarship funded by a grant from Philip Morris’s FSFW. McGrady, a 23-year-old journalist based in Colorado, said in an interview that his scholarship is for $10,000 and that he chooses the topics of his articles himself.

Glover has her own ties to industry funding. She works for the Centre of Research Excellence: Indigenous Sovereignty and Smoking, an organization focused on reducing tobacco related harm among indigenous peoples. It was granted $978,449 from FSFW in 2018. Glover cited the FSFW’s “complete autonomy” from Philip Morris and the tobacco industry, and said she has never received funding from any vaping or tobacco product company.

Filter Magazine itself is funded by The Influence Foundation, a New York-based nonprofit whose donors have included Philip Morris, Altria Client Services, Reynolds America and Juul Labs Inc. The Influence Foundation’s Editorial Independence Policy grants the editorial team at Filter “full authority over editorial decisions.” Juul said it has “no involvement in the editorial of Filter.”

Some of the messages dismissing vaping or smoking’s connections to the virus also criticize regulators or those who have advocated for tobacco control, including Michael R. Bloomberg. Bloomberg has campaigned and given money in support of a ban on flavored e-cigarettes and tobacco. He is the majority owner of Bloomberg LP, the parent company of Bloomberg News. His charity, Bloomberg Philanthropies, has funded Legendre’s group, Corporate Accountability, most recently in 2018.

Financial Stakes

At stake in all this are the lives of the estimated 1.1 billion people around the world who smoke, and the 41 million who vape.

So is the financial health of tobacco and vape companies, which could see sales suffer if their products are linked to yet another deadly disease. In early April, a lawsuit from individuals and school districts against Juul Labs and Altria that seeks medical monitoring and damages related to youth vaping was updated to include claims about the coronavirus. If companies are held liable for some costs of the pandemic, it could also give rise to something akin to the 1998 settlement that forced tobacco companies to pay more than $100 billion to U.S. states for costs from diseases like lung cancer.

Whether the warring messages even reach nicotine’s most vulnerable audiences — like the estimated 1 in 5 high school students who vape — remains to be seen. Laura Heaney, the 18-year-old president of Southampton High School’s chapter of Students Against Destructive Decisions, said few of the 30 people she knows who vape even think about what it might mean for the coronavirus. “The ones that do blow it off casually,” she said. “They think, worst case scenario, they will just get the common cold.”

Meanwhile, the messages made with the aid of tobacco and vape money continue to ping their way around the world. Some even ask for donations. “This is an urgent appeal to help people coping with the trail of disease, death and devastation that the coronavirus pandemic is bringing to the world,” says a message on the website of the Center of Excellence for the Acceleration of Harm Reduction in Catania, Italy.

The center received money from Philip Morris’s foundation in 2018. Its director, Riccardo Polosa, has a long history of work for the tobacco industry. Polosa said in an email that the center is independent “no matter the funding source.” In a separate Filter magazine article, he said he ensured vape shops weren’t closed in Italy during the virus lockdown. The idea that you are at higher risk of getting Covid-19 if you smoke or vape, he said in the article, is “just a game that is trying to create a new hysteria.”

(Corrects story originally published on April 17 to clarify the nature of the relationship between INNCO and two of its member organizations, in paragraphs 15 and 16.)

Tobacco, vaping industries seize opportunities in coronavirus with freebies, donations

 

Running low on surgical masks during the pandemic? You can get two for free by ordering a Moti Piin, a battery-powered vaping pen, from the company’s online shop.

Or buy sleek cartridges from Smok, another e-cigarette brand, and earn chances to win disposable gloves and up to 10,000 masks.

“COVID19 RELIEF EFFORT” blasts the ad of another online shop offering two-for-one e-liquid vials. Buyers at another shop get 19% off nicotine e-juices if they enter the code COVID-19.

As the global pandemic strains the world’s inventory of medical supplies, the tobacco and vaping industries are taking advantage of a unique opportunity, offering freebie protective gear, doorstep deliveries and festive pandemic-themed discounts. Some players have donated ventilators and mounted charity campaigns.

The tobacco companies insist they are simply doing their part to help during the crisis. But the coronavirus-related marketing has been criticized by anti-smoking advocates who call it hypocritical and potentially dangerous. They note that people with lungs damaged by smoking are at an elevated risk if they catch the virus, and that vaping has been linked to a growth in tobacco use, particularly among teens.

“It’s as if they don’t realize they’re in the business of destroying lungs,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids. “It literally takes your breath away. It makes the word ‘hypocrisy’ feel feeble.”

Researchers have long known the dangers of tobacco products, which kill more than 8 million people each year, according to the World Health Organization. Smoking weakens a person’s ability to fight off respiratory infections and drives up their risk of developing the types of chronic lung conditions that underlie many of the most severe coronavirus cases.

Health officials are adding the pandemic to their long list of reasons that people should quit. E-cigarettes can be efficient carriers of the virus, they note. They are often passed around and shared; smokers frequently touch their face and mouth. The smoke and vapor that waft through the air could spread infectious particles to people and surfaces nearby, say scientists.

But the American Vaping Assn. circulated an editorial in late March that urged state officials to lift bans of online e-cigarette sales, arguing that online sales promote safety because it keeps people from making trips outside their home. Continued access to e-cigarettes prevents people from relapsing back into smoking cigarettes, they added.

In one doorstep delivery promotion, a woman beams as she opens her vaping package, her fists raised in the air. In another, hand-in-hand models ask customers to help “build a community with a shared future for humanity.”

“Hurry and save today,” an Instagram ad said, with the hashtags #corona, #quarantine, #vapenation.

Research published in American and Chinese journals already suggests that tobacco users often fare worse with coronavirus infections. The effects of vaping on a case of COVID-19 are less conclusive, but scientists say a surge of lung infections tied to the habit last summer gives them reason for worry. “Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape,” the National Institute on Drug Abuse, part of the National Institutes of Health, warned in a statement last month.

The tobacco industry has used the moment to enhance its public image, especially with charitable giving. The world’s biggest tobacco company, Philip Morris International, donated 50 ventilators to the government of Greece, which has one of the highest smoking rates in Europe. The country has seen 2,100 cases of COVID-19, and at least 100 people have died.

The company, which holds 40% of the Greek tobacco market, did not appear to publicize its donation and did not respond to an inquiry from The Times.

Gov. Ralph Northam of Virginia has asked tobacco companies to take on a similar role and supply respirator masks in the United States.

Altria, the maker of Marlboro cigarettes, announced a $1-million relief investment to help support vulnerable residents surrounding its headquarters in Richmond, Va., and other regions where manufacturing takes place. Caring for each other and doing what’s right is core to our company,” Jennifer Hunter, the company’s senior vice president for corporate citizenship, said in a statement.

Altria said in a statement that its companies were “working to protect their employees, consumers and communities from the virus.”

Meanwhile, vape manufacturers and retailers are donating bottles of hand sanitizer to local police and fire departments across the country, according to the Smoke-Free Alternatives Trade Association.

Individual vaping companies did not respond to inquiries from The Times.

In Los Angeles, smoke shops have been among the businesses most resistant to orders that they close. Los Angeles prosecutors have filed criminal charges against two smoke supply establishments, accusing them of refusing to comply with the city’s strict Safer at Home order intended to slow the spread of the virus.

On the store shelves, N95 respirators and hand sanitizer tubes are stacked beside glass bongs and e-liquids. “TIMES ARE TUFF,” one shop’s signage read. “WE GOT YOU.”

“We had a smoke shop that just refused to close,” Mayor Eric Garcetti said. “And even when police officers were there, they said, ‘Forget you’ — probably not in as nice words — ‘we’re not going to do it.’” He said the city was going to move to shut off the shop’s power.

Unexpectedly high numbers of younger people have become severely ill from the virus, and some experts suspect a link to vaping. “The COVID-19 crisis should be a wake-up call that your age doesn’t matter if your lungs are compromised,” Myers said.

Most of the companies’ websites still include legally required disclaimers about age restrictions. But the flavors range from Oatmeal Cookies and Yogurt Drink to Blueberry Parfait and Watermelon Rush, a colorful cartridge displayed in its promotion next to a bright glass of juice. The Food and Drug Administration attempted to ban such flavors years before the trend ballooned among teenagers, only to have the plan rejected by top White House officials, a Times investigation found last year.

There may be a silver lining to e-cigarette sales during the extended quarantine. It’s much harder for addicted teenagers to keep the habit a secret, Myers said.

“Tens of thousands of parents are likely realizing for the first time: Their kids are definitely still vaping.”

 


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Coronavirus and smoking

Dr. Rob Crane, clinical professor in the Department of Family Medicine at the Ohio State University and president of the Preventing Tobacco Addiction Foundation, explains why smokers and vapers are at greater risk for developing serious health problems as a result of contracting COVID-19, the disease caused by the coronavirus.