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One more reason to quit smoking

LIMA — Smokers have a harder time fighting off respiratory infections and are at higher risk for developing chronic lung disease — two factors associated with severe cases of COVID-19, the disease caused by the novel coronavirus — which is why some doctors are encouraging smokers to quit now to improve lung function before they get sick.

Researchers are still trying to determine the extent to which smoking itself can be attributed to worse outcomes from COVID-19, after preliminary studies in the U.S. and China found a possible link between the two.

“We know they have chronic inflammation of the lower lung,” said Dr. Rob Crane, a clinical physician with The Ohio State University Department of Family Medicine. “The air sacs tend to be more irritated. The basement membrane, that bottom lining of the lung, tends to get more broken up. You have cilia cells that don’t function in their reactions as well. And most acutely, the moment you inhale nicotine, it paralyzes the little hair cells, the cilia, that are the sweepers of the lung cleanup system.”

Oxygen diminishes when the lungs are congested with junk and fluid.

“That’s what kills people,” Crane said. “That’s why you find doctors trying to reposition people; put them on their stomach or sitting up or turned on their side so they can get that fluid drained different places and allow some parts of the lung to continue to ventilate.”

Crane, who is involved in tobacco cessation efforts and is the founder of the Preventing Tobacco Addiction Foundation, is one of the doctors using the coronavirus pandemic to encourage smokers to quit.

“There could hardly be a better motivator now than the risk of a horrendous death,” he said. “There are deaths and then there are deaths. But this death, where you asphyxiate, where you drown in your own secretions and then you go onto a ventilator and you probably don’t get off — you can’t say goodbye to your loved ones; you die alone — that’s right up there with really bad deaths.”

There were about 34.2 million active smokers in the U.S. in 2018, which accounts for about 14% of the adult population, according to the Centers for Disease Control and Prevention. But smoking is more common in Ohio, with about 21% of adults considered active smokers in 2017.

Crane said lung inflammation decreases just days after a person quits smoking. While the lung is not healed entirely, Crane explained those improvements help decrease the chances for chronic illness like heart disease.

Whether those changes are enough to improve a person’s chances of survival from COVID-19 are less clear.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, wrote earlier this month that COVID-19 “could be an especially serious threat to those who smoke tobacco or marijuana or who vape” because the disease attacks the lungs. Likewise, she warned people with opioid and methamphetamine use disorders may also be at higher risk.

But even if active smoking is not directly related to COVID-19 complications, Crane said there are other benefits to quitting, like decreased risk of chronic disease. He said the most effective methods include smoking cessation medications and nicotine substitutes.

Mackenzi Klemann is a reporter with The Lima News.

Big Tobacco, Big Hypocrisy

As if it weren’t appalling enough when the Wall Street Journal reported on April 4 that both British American Tobacco PLC and Philip Morris International Inc. are in the process of developing a potential vaccine for COVID-19, the LA Times published on April 17, 2020 an expose’ of how the tobacco and vaping industry is exploiting the pandemic to push its deadly and addictive products.

So, which is it, Big Tobacco: Do you want to save our lungs or destroy them? Do you care enough about our lungs to stop making and selling your deadly products, the use of which is attributed to 500,000 deaths per year in the U.S.

Apparently not…

The L.A. Times writes:

‘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.’

While COVID-19 is a serious threat, so too is tobacco. Not only is smoking a likely risk factor for COVID-19, it is also associated with countless other diseases, including cancers, heart disease and COPD, not to mention addiction.

Tobacco use is the single most preventable cause of death. Tobacco kills almost 500,000 Americans every year, more than all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.  If Big Tobacco really cared about your health, then they’d cease production of this harmful product.

If Big Tobacco cared about your lungs it wouldn’t be addicting a new generation through predatory marketing, innovative flavors, and nicotine products.

In 2019, over 35% of high school seniors reported tobacco product use in the last 30 days. This skyrocketing in youth use came at a time when youth combustible use was at an all-time low. Big Tobacco recognized this problem in their consumer base and engaged in deliberate campaigns to hook the next generation. They were successful: millions of middle schoolers and high schoolers who would never have smoked cigarettes are now using e-cigarettes regularly, many of them seriously addicted, and the trend shows no sign of abating.

In an infamous memo from a Lorillard Tobacco Company executive to the former Lorillard President regarding the Newport cigarette brand, the executive wrote, “the base of our business is the high-school student.” Tobacco companies are aware that if they do not engage new users by their early twenties, they most likely never will. With this knowledge and in response to a decline in combustible cigarette use among our youth, the tobacco industry, including companies like JUUL, deliberately used and continues to use innovative products and flavors and predatory marketing to attract the next generation of smokers.

As COVID-19, a highly contagious and sometimes life-threatening lower respiratory disease, looms ever-present in our lives everyday now, Big Tobacco wants to help YOU stay healthy? This is not only appalling, it’s downright vile. Indeed, if Big Tobacco cared about your health, it wouldn’t advertise, promote, and give away products that addict and make you sick, exploiting your fears and vulnerability at this challenging and unsettling time.

Big Tobacco should consider using the COVID-19 pandemic downtime to reassess its business model which profits from addiction, disease, despair, and death.

E-cigarette sales still strong even without flavored products: Study

Before COVID-19 was dominating headlines, many Americans were concerned about another deadly epidemic: vaping.

It’s been linked to more than 2,800 hospitalizations and deaths, though health officials haven’t linked any specific substance or products to the illnesses, and no single product has been associated with all of the cases.

E-cigarette sales in the United States steadily rose from 2016 to 2018, with youth-friendly, candy- and fruit-flavored products that critics say targeted teens fueling most of that growth. Facing mounting criticism as reports of vaping-associated lung disease rose, the popular vaping brand JUUL ended in-store sales of fruit- and candy-flavored products in November 2018.

But, according to a new study, those actions have had little effect. Sales of e-cigarettes remain strong even after the measures taken to curb purchases of youth-friendly products, raising questions about federal regulations and how to best protect American youth from harming themselves by vaping.

After companies stepped in to self-regulate, e-cigarette sales dropped for about two months but quickly rebounded, soon exceeding previous highs, according to the study by the American Cancer Society published in the American Journal of Public Health.

The study’s authors said the data show a glaring shortcoming in allowing e-cigarette companies largely to self-regulate in lieu of coordinated federal regulations. In December, more than a year after JUUL stopped selling fruit- and candy-flavored products, Congress did ban the sale of all tobacco and e-cigarettes to anyone younger than 21.

A spokesperson for JUUL told ABC News that the company is working closely with regulators, attorneys, public health officials and other stakeholders to combat underage use of its products and “will continue to reset the vapor category in the U.S. and seek to earn the trust of society.” Juul has also long maintained its products are intended for adults looking to switch from combustible cigarettes.

The Food and Drug Administration, which regulates tobacco products, said it was reviewing the findings of the recent study, which will be evaluated as part of a larger body of evidence.

The study, based on sales figures from the market research firm Nielsen, only collected data from brick-and-mortar retailers and may not show the whole picture. Online sales of vaping products could be much higher, especially among younger buyers, according to experts.

“The trends being reported in this paper are likely to be an underestimate of the total volume of sales across the country,” said Dr. Andy Tan, a public health researcher at Dana-Farber Cancer Institute.

The study didn’t track purchases by individual customers and wasn’t broken down into age groups. Nevertheless, the data offers a “snapshot” of e-cigarette sales over time in certain stores and suggests vaping continues to be popular despite the voluntary removal of fruit- and candy-flavored products by e-cigarette companies, Tan noted.

Outside surveys have corroborated the idea that many middle school and high school students simply switched to mint, menthol and tobacco flavors. Believing that the removal of a few flavors of a highly successful product would make a significant dent in usage is “highly naive,” Tan added, “because these products are highly addictive.”

Alex Liber, one of the study’s lead scientists, added: “JUUL was able to transition sales of other flavors easily by simply swapping which flavors were being displayed in stores.”

JUUL’s sales also likely got a boost, Liber added, thanks to new part-owner Altria, a massive distributor of tobacco products that also owns Philip Morris USA, the producer of Marlboro cigarettes.

From 2016 to 2019, according to a National Youth Tobacco survey, flavor preferences among high school students shifted, with those vaping menthol or mint flavors increasing to 57% from 16%.

Ultimately, the researchers concluded that JUUL’s self-regulation was insufficient to curb the use of these products, although it’s too soon to determine how big of an impact changing the legal purchasing age to 21 may have.

“Business acts to serve its own interests,” Liber said, “while well-constructed government regulation can serve the public interest.”

Heather J. Kagan, M.D., an internal medicine resident physician at The Johns Hopkins Hospital, is a contributor to the ABC News Medical Unit. Sony Salzman is the unit’s coordinating producer.

Are Smokers or Vapers More at Risk for COVID-19? Here’s What We know

Investigating the potential danger to those who use tobacco products or e-cigarettes calls for a look at the lungs

Pandemics seem to have a way of reminding us about things we might normally take for granted: The feel of a hug or handshake. The number of times we touch our faces or wash our hands each day. Even our intake of breath—and what it might feel like if COVID-19 blocked our ability to breathe as effortlessly as we normally do.

This is a moment in history that has many of us thinking more about our lungs than we ever have before.

Lungs do amazing things invisibly. They contain an array of around 1,200 miles of capillaries and 300 million tiny sacs. When we breathe, our heart circulates blood past those tiny gas exchangers to fuel every cell in the body.

As the SARS-CoV-2 pathogen spreads across the world, researchers are racing to figure out how this new viral foe steals that ability from us. Part of the work involves finding preexisting health factors that might allow the disease it causes to change from a bad—but beatable—respiratory bug to a deadly threat.

Early pathological studies from the pandemic have revealed some risk factors for the most severe forms of COVID-19. Among the most important: being older and having a  chronic underlying illness.

Smoking and vaping are also being actively investigated as risk factors. A wealth of research already suggests that smoking suppresses immune function in the lungs. It is also known to increase the risk  of influenza. And while there are very little data on e-cigarette use and infectious disease risk, the recent outbreak of deadly vaping-related lung illnesses sensitized both the scientific world and the public to the potential harms associated with that practice.

In this video by Scientific American’s reporting partner Retro Report, we see that while COVID-19 is brand-new, the scientific approach to treating people who get it cannot rely on understanding SARS-CoV-2 in isolation alone. Treatment must also take into account the unique history and susceptibility of each patient’s airway. Doing so means understanding, and factoring in, personal habits, including smoking and vaping.

The younger kids are when they start smoking, the more likely they’ll still be smoking in middle age, says U of M study

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Children and teens who smoke — even if they have tried it only a few times — are more likely to be smoking daily during their 20s and less likely to have quit smoking by their 40s, according to a University of Minnesota study published Wednesday in the Journal of the American Heart Association.

Furthermore, the younger children are when they begin experimenting with cigarettes or the more often they smoke, the greater their chance of becoming full-fledge smokers during adulthood.

Children who first try smoking around the ages of 14 and 15 are, for example, six times more likely to be smoking in their 20s than those who puff on their first cigarette at age 18 or 19, the study found.

“We really should be doing everything we can to keep cigarettes out of the hands of children,” said David Jacobs, the study’s senior author and an epidemiologist at the U of M, in a phone interview with MinnPost.

“You have to keep never smoking until you are of age in order to have the real minimal risk of never becoming an adult smoker,” he added.

Although the prevalence of smoking has dropped dramatically among American teens in recent years — from 40 percent of 12 graders in 1995 to about 10 percent in 2018 — a still significant number of young people smoke. Each day, some 1,600 children and teens light up their first cigarette, according to the Centers for Disease Control and Prevention. And the number of young people using electronic cigarettes has risen rapidly recently — from 3.6 million in 2018 to 5.4 million in 2019.

Those discouraging figures formed the impetus behind legislation passed late last year by Congress and signed into law by President Trump that increased the minimum age for the sale of tobacco products from 18 to 21.

The current study isn’t the first, of course, to report that smoking during childhood raises the risk of continuing the habit during adulthood. In the United States, for example, it’s long been known that 9 in 10 adult smokers began smoking when they were kids. This study is the first, however, to follow the smoking habits of people from childhood into midlife. Most other studies have not been prospective, but have, instead, asked people to look back and recall when they started smoking. Such recollections can be inaccurate.

How the study was done

For the study, Jacobs and his co-authors analyzed smoking information on more than 6,600 people from the United States, Australia and Finland who were followed from childhood into midlife as part of the International Childhood Cardiovascular Cohort Consortium. The researchers looked specifically at smoking data collected at three points in the participants’ lives: when they were 6 to 19 years old (in the 1970s and 1980s), when they were in their 20s, and then again when they were in their 40s.

The analysis revealed that the age at which someone began smoking during childhood made a significant difference in whether they continued to smoke into their adulthood. Half of those who first tried smoking by age 14 were smoking daily in their 20s, compared to 33 percent for those who first tried at age 15 to 17 and 8 percent of those who first tried at 18 to 19.

Very few — 2.6 percent — of the participants began smoking when they were out of their teens.

“There’s a very small probability that you will become an adult smoker if you don’t start by adolescence,” said Jacobs.

The analysis also found that the intensity with which young people smoked — how often they lit up a cigarette — also predicted whether they became daily smokers in adulthood. For example, 86 percent of the participants who smoked daily between the ages of 15 and17 went on to do the same in their twenties, and 59 percent were still smoking daily in their 40s. By comparison, 49 percent of the participants who were regular, but non-daily, smokers between the ages of 15 and 17 went on to become daily smokers in their 20s, and 29 percent of them were still smoking daily in their 40s.

Yet, even children who only dabbled in smoking — puffing on a few cigarettes here and there — were at risk of becoming adult smokers. And the younger they were when they started such experimenting, the greater the risk. For example, 45 percent of the 13- to 14-year-old “triers” became daily smokers by young adulthood compared to 9 percent of 18- to 19-year-old ones.

“We’ve known for a long time that it’s much harder for a heavy smoker to quit smoking than for a light smoker,” said Jacobs.

“It’s very interesting that the intensity of the adolescent smoking is still visible in the quit rates during the 40s,” he added.

Limitations and implications

The study comes with several caveats. For example, the questionnaires used for the various groups of participants did not solicit uniform sets of information about childhood smoking, a factor that may have affected the findings. Also, young people, particularly young children, can have difficulty filling out questionnaires and therefore may not have provided accurate information about their early smoking behaviors.

In addition, the study did not consider smoking products other than cigarettes — most notably, electronic cigarettes. Jacobs believes, however, that when such research is done, the results are likely to be similar to those of the current study.

As Jacobs and his colleagues emphasize in their paper, their findings underscore the need to discourage young people from using any tobacco products, including banning the sale of such products to anyone under the age of 21.

“We really should do everything we can to keep them out of the hands of children, said Jacobs.

“If you have any influence with your child, the best thing you can do is give strong advice to not smoke,” he added.


For more information:  The study, which was funded in part by the National Heart, Lung, and Blood Institute, can be read in full on the Journal of the American Heart Association’s website.