CHARLES A. FRUEAUFF FOUNDATION .

>> Bonnie: HELLO AND WELCOME TO "TO THE CONTRARY".

I AM BONNIE ERBE.

AS THE COVID-19 PANDEMIC CONTINUES, WE ARE FOCUSING ON THE IMPACT OF VAPING AND SMOKING, ON EFFORTS TO CURB THE DISEASE AND WHETHER THESE HABITS PUT PEOPLE AT A GREATER RISK OF A NEGATIVE OUTCOME IF THEY DO GET THE NOVEL CORONAVIRUS.

WE ARE SPEAKING WITH EXPERTS IN THE FIELD.

UP FIRST, WE BEGIN WITH STATE AND GLANCE PROFESSOR OF MEDICINE AND DIRECTOR OF THE CENTER FOR TOBACCO RESEARCH CONTROL AND EDUCATION AT THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO.

HELLO, DR. GLANCE.

>> HELLO.

>> Bonnie: TELL US ABOUT THE RESEARCH IS CONDUCTED INTO THE EFFECTS OF E CIGARETTES IN VAPING.

>> Dr. Glance: THE WAY A CIGARETTE WORKS IS YOU SET THE TOBACCO ON FIRE, AND THAT GENERATES AN AEROSOL OF ULTRAFINE PARTICLES THAT CARRIES NICOTINE, WHICH IS THE ADDICTIVE DRUG AND TOBACCO, DOWN DEEP IN YOUR LUNGS WHERE IT'S ABSORBED.

NOW, WHEN YOU SET TOBACCO ON FIRE, YOU GET A LOT OF BAD CHEMICALS IN THE COMBUSTION PRODUCTS.

SO THE IDEA OF AN E-CIGARETTE IS YOU GENERATE AN AEROSOL OF ULTRAFINE PARTICLES TO CARRY NICOTINE DOWN INTO YOUR LUNGS BY HEATING UP A LIQUID, SO YOU DON'T HAVE ALL OF THE BAD COMBUSTION PRODUCTS.

AND THE ARGUMENT WAS, WELL, WITHOUT COMBUSTION PRODUCTS, E CIGARETTES ARE GOING TO BE A LOT SAFER THAN A CIGARETTE.

WE HAVE BEEN STUDYING THE EFFECTS OF CIGARETTES ON HEART AND LUNG DISEASE.

WHAT WE FOUND IS THAT, WHILE THE EXACT NATURE OF THE CHEMICALS THAT YOU ARE INHALING OF AN E-CIGARETTE ARE DIFFERENT FROM A CIGARETTE, THE OVERALL EFFECT IS ABOUT THE SAME.

ALSO, THERE IS RESEARCH, NOT DONE BY US, BUT SHOWING THE FLAVORING AGENTS IN E CIGARETTES, MANY OF THEM ARE HIGHLY TOXIC TO YOUR LUNGS AND YOUR CARDIOVASCULAR SYSTEM.

>> Bonnie: PLEASE TELL US ABOUT YOU VALLEY.

WHAT IS THAT?

HOW DOES IT PLAY INTO THE COVID EPIDEMIC, IF AT ALL?

>> Dr. Glance: WELL, E VALEI STANDS FOR E-CIGARETTE IN VAPING -INDUCED LUNG INJURY YEAH.

AND LAST SUMMER, THERE WERE THOSE STATE OF MOSTLY YOUNG PEOPLE GETTING VERY SEVERE LUNG ILLNESS FROM USING E CIGARETTES.

ONE OF THE CAUSES OF EVALI THAT'S BEEN IDENTIFIED AS A COMPETENT CHEMICAL CALLED VITAMIN E ACETATE WHICH IS USED IN ONE OF MARIJUANA OR TEACH E-CIGARETTE!

THIS IS AN OILY SUBSTANCE, LITTLE TINY OILY DROPLETS, THESE MIGHT BE NANO, MICROPARTICLES OF OIL CURED INTO THE LUNGS BY CIGARETTES.

THEY CLOG UP IN THE CELLS CALLED MACROPHAGES WHICH ARE CELLS DEEP IN YOUR LUNGS THAT GOBBLE UP VIRUSES AND BACTERIA AND CLOG UP MACROPHAGES JUST STOP WORKING.

NOT ONLY DON'T GOBBLE UP VIRUSES AND BACTERIUM, BUT THEY ACTUALLY START BLOCKING YOUR LUNGS.

>> Bonnie: YOUR GROUP, THE TOBACCO CENTERS OF REGULAR -- REGULATORY SIRENS, HAVE NOW BECOME PART OF THE FDA?

>> Dr. Glance: FDA WORKING WITH NIH HAS 29 BIG RESEARCH CENTERS AROUND THE COUNTRY CLUB TOBACCO CENTERS OF REGULATORY SCIENCE, THE COURSE.

I'M THE PRINCIPAL INVESTIGATOR OF THE ONE AT UC SAN FRANCISCO.

SO THEY ARE FUNDED BY THE FDA, BUT WE ARE NOT PART OF THE FDA.

WE MEET WITH THEM MONTHLY AND TRIED TO PRODUCE RESEARCH WHICH WILL HELP INFORM TOBACCO PRODUCT REGULATION.

BUT WE ARE INDEPENDENT.

IN FACT, WE HAVE PROBABLY PUT IN 50 OR 75 PUBLIC COMMENTS TO THE FDA CRITICIZING THEM FOR INACTION ON EACH CIGARETTE, IN INACTION ON EACH FLAVORS.

WE THINK THE RECENT APPROVAL OF ICONS, WHICH IS A HEATED TOBACCO PRODUCT WHICH PHILIP MORRIS PROBABLY BROKE THE LAW.

>> Bonnie: TELL ME, PLEASE, WHAT IS IT THAT YOU HAVE PRODUCED WHEN IT COMES TO VAPING AND TEENAGERS?

>> Dr. Glance: WE HAVE SHOWN THAT TEENAGERS, A LOT OF THEM, DON'T KNOW THAT THAT THERE IS NICOTINE IN E CIGARETTES AND THAT IS ADDICTIVE.

THEY PERCEIVE THEM AS BEING LESS RISKY THAN CIGARETTES.

HAVE DONE A LOT OF WORK.

IN FACT, THIS IS SOMETHING I HAVE PERSONALLY DONE SHOWING E CIGARETTES ARE A GATEWAY TO CIGARETTE SMOKING FOR KIDS, ABOUT THREE QUARTERS OF THE KIDS WHO START NICOTINE USE WITH E CIGARETTES, IF YOU LOOK AT THEIR RISK PROFILE IN TERMS OF THE PSYCHOLOGY, THE DEMOGRAPHICS, YOU WOULD PREDICT THEY WOULD NEVER PICK UP A CIGARETTE.

WE HAVE ALSO DONE A LOT OF RESEARCH WORKING IN THE TOBACCO INDUSTRY, INTERNAL DOCUMENTS.

WE HAVE ALMOST 100 MILLION PAGES OF PREVIOUSLY SECRET TOBACCO INDUSTRY INTERNAL DOCUMENTS.

AND MANY OF US HAVE GONE BACK TO SEE WHY DID THE TOBACCO COMPANIES DEVELOP E CIGARETTES IN THE FIRST PLACE?

AND IT WAS NOT FOR HARM REDUCTION OR TO HELP PEOPLE QUIT SMOKING, IT WAS TO HOLD ONTO SMOKERS, BECAUSE WHAT THEY FOUND WAS A LOT OF PEOPLE WERE QUITTING SMOKING AND THEY WANTED TO DEVELOP ALTERNATIVE PRODUCTS THAT PEOPLE WOULD PERCEIVE AS SAFE OR EVEN THOUGH THE INDUSTRY NEVER DEMONSTRATED THAT AS AN EXPERT ON VAPING AND SMOKING, DO YOU BELIEVE PARTICULARLY VAPING E CIGARETTES HAVE PLAYED ANY ROLE IN EXPANDING THE TRANSMISSION OF COVID-19?

>> Dr. Glance: I DON'T THINK THAT CIGARETTES OR E CIGARETTES PER SE EXPAND THE TRANSMISSION OF COVID-19.

THERE HAS ONLY BEEN ONE STUDY THAT I COULD FIND THAT LOOKED AT THIS QUESTION.

IT LOOKED AT IT IN THE CONTEXT OF INFLUENZA AND ASKS WHETHER THE AMOUNT OF FLU VIRUS EXHALED BY SMOKERS IS DIFFERENT THAN THE AMOUNT OF FLU VIRUS EXHALED BY NON-SMOKERS.

THE SMOKING ITSELF DID NOT MAKE ANY DIFFERENCE.

NOW, THERE MIGHT BE SOME INDIRECT EFFECTS.

FOR EXAMPLE, YOU COUGH MORE IF YOU SMOKE OR VAPOR.

AND THAT WOULD EXPEL MORE VIRUS.

YOU HAVE MORE HAND TO MOUTH ACTIVITIES, WHICH WOULD PROBABLY PROMOTE TRANSMISSION.

BUT IF YOU ASK THE QUESTION, DOES THE FACT THAT YOU ARE INHALING THIS AEROSOL OF EITHER TOBACCO SMOKE AFFECT THE AMOUNT OF VIRUS THAT GIVES EXHALED ON A BREATH?

THE ANSWER TO THAT, AGAIN, BASED ON ONE STUDY, BUT IT SEEMS TO BE NO.

>> Bonnie: A LOT OF THE PUBLIC DON'T REALIZE, THOUGH IT'S BEEN REPORTED, THAT MANY OF THE PEOPLE WHO GET THROUGH THE VIRUS ITSELF SUSTAINED SEVERE LIFELONG LUNG PROBLEMS.

SO WOULD A PERSON WHO VAPES BE, YOU KNOW, PREDISPOSED TO NOT BEING ABLE TO FIGHT OFF THE VIRUS AS WELL AS SOMEBODY WHO DOES NOT?

>> Dr. Glance: WE HAVE PUBLISHED A PAPER JUST RECENTLY WHERE WE LOOKED AT THE WORLD LITERATURE ON THE QUESTION OF, DOES SMOKING AFFECT DISEASE SEVERITY AMONG PEOPLE ONCE THEY GET INFECTED WITH COVID?

AND WHAT WE FOUND WAS THAT IF YOU ARE A SMOKER, IT ABOUT DOUBLES THE ODDS THAT YOU WILL GET SEVERELY ILL DEFINED IN A VARIETY OF WAYS.

AND THE REASON FOR THAT IS PROBABLY BECAUSE SMOKING DEPRESSES YOUR IMMUNE SYSTEM, IT TRIGGERS INFLAMMATORY PROCESSES, AND YOU PUT YOUR BODY IN A POSITION WHERE IT'S MORE SUSCEPTIBLE TO INFECTIONS AND CANNOT FIGHT THEM OFF AS WELL.

SO FOR SMOKING AND COVID AND DISEASE PROGRESSION, THERE IS ACTUALLY QUITE SIZABLE LITERATURE WHICH SHOWS SMOKING MAKES COVID DISEASE PROGRESSION WORSE.

>> Bonnie: THANK YOU, DR. LANCE.

NOW WE ARE SPEAKING WITH DR. HUMBERTO TROY OF THE CLEVELAND CLINICND YOU AS A PULMONOLOGIST WORRY THAT THE SYMPTOMS OF VAPING LUNG INJURY MAY MIMIC THOSE OF THE CORONAVIRUS.

PLEASE TELL ME ABOUT THAT.

WHY IS THAT?

>> Dr.

Troy: SOMETHING THAT CAN BE LEARNED FROM THE OUTBREAK THAT WE HAD LAST YEAR OF ELECTRONIC CIGARETTES IN VAPING, CAUSING ACUTE LUNG INJURY, IS NOT.

WE HAVE A LOT OF YOUNG PEOPLE WHO ARE VAPING IN REPRESENTING WITH SHORTNESS OF BREATH AND LOW OXYGEN LEVELS AND ACUTE RESPIRATORY FAILURE.

AND SOME OF THEM REQUIRE MECHANICAL VENTILATION.

AND THIS IS A VERY SIMILAR PRESENTATION THAT COVID-19 CAN PRESENT, ESPECIALLY IN YOUNG PEOPLE, BECAUSE THE SYMPTOMS CAN BE VERY NONSPECIFIC.

>> Bonnie: I REMEMBER A BUNCH OF YOUNG PEOPLE DIED I BELIEVE IT WAS IN WISCONSIN.

THERE WERE DEATHS NOT T JUST IN INJURIES AND NOT ON ARTIFICIAL LUNGS, BUT DEATHS FROM VAPING, CORRECT?

>> Dr.

Troy: YES.

THIS WAS ACROSS THE COUNTRY.

I THINK THIS WAS FIRST IDENTIFIED IN A CLUSTER OF CASES IN WISCONSIN AND ILLINOIS.

BUT THERE WERE KISSES ALL OVER THE COUNTRY.

AND THEY WERE CASES SEVERE ENOUGH THAT REQUIRED VENTILATION AND THERE ARE DOZENS OF DEATHS RELATED TO LUNG INJURY TO VAPING.

LAST YEAR ONE OF THE STUDIES SHOW THAT IS ACTUALLY THE LIQUID THAT CONTAINED VITAMIN E WAS ONE OF THE RESPONSIBLE SUBSTANCES THAT WAS CAUSING THE LUNG INJURY.

NOW, IT IS MORE PREVALENT AMONG YOUNG PEOPLE IN HIGH SCHOOL IS, JUST BECAUSE THAT'S THE DEMOGRAPHIC THAT WAS USING ELECTRONIC CIGARETTES MORE OFTEN THAN OTHERS.

>> Bonnie: IS THE CORONAVIRUS ONE THAT SEEMS TO ATTACK THE LUNGS MORE THAN, SAY, THE HONG KONG FLUTED OR SARS OR ANY OF THE OTHER PANDEMICS THAT HAVE TAKEN PLACE?

>> Dr.

Troy: THESE OTHER VIRAL INFECTIONS DAY PRIMARILY BECAUSE MORE ALONG INJURY.

NOW, THE CORONAVIRUS IS SPECIFICALLY CONCERNING BECAUSE ONE OF THE WAYS THAT THE VIRUS CAN AFFECT THE LUNGS IS BY ATTACHING ITSELF TO SOME RECEPTORS THAT ARE IN THE LINING OF THE AIRWAYS AND IN THE LUNGS.

AND THAT KIND OF RECEPTOR SEEMS TO BE UPREGULATED BY SMOKING AND POSSIBLY BY VAPING.

SO ONE OF THE HYPOTHESIS IS THAT SMOKERS AND PEOPLE WHO VAPES COULD BE AT HIGHER RISK OF CONTRACTING COMPARED TO PEOPLE WHO DO NOT SMOKE.HIS IS SPECULATION, BUT IT'S DEFINITELY ONE OF THE THINGS THAT WE ARE LOOKING INTO AND HOPEFULLY SOON WE WILL LEARN MORE.

>> Bonnie: DO YOU THINK THERE SHOULD BE MORE OF AN EMPHASIS BY THE MEDIA ON THE POSSIBLE IMPACT OF SECONDHAND SMOKING ON TRANSMISSION OF COVID?

>> Dr.

Troy: NOW, HOW COVID-19 AFFECTS SMOKING OR HOW THE SMOKING AFFECTS HOW THE COURSE OF THE DISEASE IS, THIS IS STILL UNKNOWN.

SO I THINK RIGHT NOW WE NEED TO FIND A LOT OF THESE ANSWERS FIRST BEFORE WE HAVE MORE OPEN DISCUSSION ABOUT THIS.

BUT I WILL SAY EVERY TIMES WHEN WE TALK ABOUT, YOU KNOW, WHEN TO QUIT SMOKING AND VAPING.

>> Bonnie: IS IT MORE LIKELY THAT SOMEONE WHO SMOKES OR VAPES, IS THAT PERSON MORE LIKELY TO CONTRACT COVID?

DO WE KNOW ANYTHING ABOUT THOSE NUMBERS YET?

>> Dr.

Troy: THERE WERE SOME SMALLER STUDIES THAT WERE PRIMARILY COMING FROM ASIA THAT WERE SHOWING THAT MAYBE MEN WHO SMOKED WERE MORE LIKELY TO ACQUIRE THIS INFECTION.

>> Bonnie: BUT WHY MEN MORE THAN WOMEN?

IS THERE SOME HORMONAL DIFFERENCE THAT COULD MAKE MEN MORE SUSCEPTIBLE?

>> Dr.

Troy: THIS IS NOT VERY CLEAR, BUT AT LEAST IN THOSE STUDIES IN ASIA, THE DIFFERENCE WAS MOSTLY FROM SMOKING, BECAUSE IN ASIA THE PREVALENCE OF SMOKING IS MUCH HIGHER IN MEN COMPARED TO WOMEN.

>> Bonnie: ARE THERE ISSUES THAT PEOPLE SHOULD PAY ATTENTION TO, WHETHER IT BE COVID-19 OR ANOTHER PANDEMIC, THAT THEY MIGHT NOT BE AWARE OF SYMPTOMS THAT ARE ASSOCIATED WITH THE VIRUS?

>> Dr.

Troy: SOMETHING THAT'S INTERESTING THAT WE ARE LEARNING NOW IN THIS PANDEMIC THAT ARE A LOT OF SYMPTOMS THAT WERE NOT RECOGNIZED BEFORE, AND WE ARE RECOGNIZING NOW, FOR EXAMPLE, THE LOSS OR SENSE OF SMELL OR THE APPEARANCE OF WHAT PEOPLE CALL THE COVID TOES.

THESE ARE ALL NEW SIGNS AND SYMPTOMS THAT WE ARE LEARNING MORE.

AND NOW DURING THE PANDEMIC, WHEN THERE IS A QUESTION OF WHETHER THIS IS RELATED TO THE DISEASE OR NOT, I THINK THE BEST THING IS REALLY TO TRY TO REACH OUT TO A HEALTHCARE PROVIDER AND GET TESTED IF POSSIBLE AND SEE IF MAYBE THAT HAS ANY CONNECTION TO THE INFECTION.

>> Bonnie: WHAT ARE WE FIGHTING ABOUT PEOPLE WHO SURVIVED THE VIRUS?

ARE ANY OF THESE EFFECTS THAT THEY GET LIKE LOSS OF LUNG CAPACITY, LIFELONG?

DO THEY HAVE TO LIVE WITH THAT FOR THE REST OF THEIR LIVES?

THE LOSS OF TASTE, DO THEY GET ALL OF THEIR SENSES BACK?

DO THEY GET ALL OF THEIR CAPACITY BACK WHEN THEY ARE DONE, OR ARE THERE LIFELONG IMPACTS?

>> Dr.

Troy: GOOD QUESTION.

AND HOW MUCH THIS INFECTION CAN LEAVE A LONG-TERM DISABILITY OR INJURIES IN THE BODY, IT DOES DEPEND ON HOW SEVERE THE INFECTION WAS.

I'M HEARING THAT MOST PEOPLE ARE RECOVERING THEIR SENSE OF SMELL.

BUT IN TERMS OF THE LUNG FUNCTION OR HOW WEAK OR STRONG THEY GET AFTER INFECTION DOES DEPEND ON HOW SEVERE THE ILLNESS WAS FOR MANY PATIENTS WHO END UP BEING IN THE INTENSIVE CARE UNIT WHO REQUIRE MECHANICAL VENTILATION, ESPECIALLY WHEN THAT HAPPENS FOR A PROLONGED TIME.

THEY MAY NOT BE THE SAME PERSON AS THEY WERE WHEN THEY WENT TO THE HOSPITAL AND THEY MAY BE DISCHARGED VERY WEAK, SO THEY MAY NEED REHABILITATION, PHYSICAL THERAPY JUST TO GET THEIR STRENGTH BACK.

NOW, SOME PEOPLE MIGHT BE SO WEAK THAT THEY NEED MECHANICAL VENTILATION FOR A PROLONGED TIME AND EVEN THE TRACHEOSTOMY.

BUT THAT DEPENDS ON HOW SOMEONE IS AFTER THIS ILLNESS, NOT NECESSARILY EVERYONE WILL HAVE A LONG-TERM DISABILITY BECAUSE OF THAT OR HAVE LOST A LUNG CAPACITY BECAUSE OF AN INFECTION, JUST LIKE WHEN SOMEONE HAS AN EXEMPTION FROM VIRUS OR PNEUMONIA, THERE MIGHT BE A PERIOD THAT LUNG FUNCTION IS NOT AS GOOD AS IT WAS BEFORE, BUT COULD POTENTIALLY RECOVER WHEN THE VIRUS IS MORE MILD.

>> Bonnie: HAVING HAD A TRACHEOSTOMY, WHICH DESTROYED ONE OF MY VOCAL CORDS, DO YOU THINK THAT -- WHICH IS A SERIOUS PROBLEM.

A REDUCED MY BREATHING CAPACITY AND HALF.

YOU THINK MOST OF THE PUBLIC UNDERSTANDS HOW SERIOUS INTUBATION IS?

I MEAN, WE HEAR THE TERM "INTUBATION" ON TV AND THE NEWS, READ IT ONLINE, BUT DO THEY REALIZE THAT IS A SERIOUS SURGERY THAT CAN CAUSE PERMANENT DAMAGE?

>> Dr.

Troy: YES.

IT IS A VERY SERIOUS THING.

AND THIS IS NOT A DECISION THAT ANYONE TAKES VERY LIGHTLY AND WE RECOMMEND INTUBATION, MECHANICAL VENTILATION OR CREATE TRACHEOSTOMY TO MEET SOMEONE.

THOUGH IT DOES HAVE POSSIBLE SIDE EFFECTS OR COMPLICATIONS, LIKE ANY MEDICAL PROCEDURE.

IT IS PART OF THE TREATMENT.

SOMETIMES TRACHEOSTOMY OR MECHANIC VENTILATION, EVEN WHEN PROLONGED TIME, IT MAY BE PART OF THE RECOVERY.

>> Bonnie: THANK YOU, DR. JOY.

NOW WE ARE SWITCHING TO EXECUTIVE PRODUCER CARI STEIN.

WE SPOKE WITH DR.'S BOOZE AND WALLY.

SHE IS A PEDIATRICIAN AND PROFESSOR AT THE UNIVERSITY OF ALABAMA.

>> THANK YOU.

TELL US A LITTLE BIT ABOUT YOUR BACKGROUND AND WHY UNDERSTANDING TOBACCO, ESPECIALLY AMONG TEENAGERS, IS IMPORTANT.

>> ,PEDIATRICIAN WHO FOCUSES ON THE INPATIENT SETTING.

SOMA PEDIATRIC HOSPITALIST.

EARLY IN MY CAREER, I NOTICED THAT SO MANY OF THE CHILDREN THAT I WAS CARING FOR WERE IN THE HOSPITAL WITH DISEASES THAT WERE EITHER CAUSED BY OR WORSENED BY TOBACCO SMOKE EXPOSURE, LIKE SECONDHAND SMOKE.

AND SO, THAT REALLY GOT ME PASSIONATE ABOUT WORKING IN THIS AREA AND ALSO REALLY BE A RESOURCE FOR THESE PARENTS WHO WERE SMOKING AND LOVE THEIR CHILDREN VERY MUCH AND WANT TO QUIT BUT DID NOT HAVE ACCESS TO RESOURCES.

>> HOW HAS VAPING EVOLVED SINCE BEING INTRODUCED MAINSTREAM?

>> THAT'S A GREAT QUESTION.

E CIGARETTES OR VAPED DEVICES WERE INTRODUCED IN THE UNITED STATES AROUND THE MID-2000'S.

I HAVE KIDS THAT ARE IN THE AGE RANGE.

AND TO THINK THAT IN MIDDLE SCHOOL, ONE OF 10 OF THOSE STUDENTS AND IN HIGH SCHOOL ONE OF EVERY FOUR ARE CONSIDERED CURRENT USERS IS SO CONCERNING TO ME.

THE SECOND IS THAT THERE HAS BEEN SIGNIFICANT EVOLUTION IN THE TECHNOLOGY.

WHEN E CIGARETTES FIRST CAME ON THE MARKET, THIS IS A BLUE CIGARETTE.

MANY PEOPLE WOULD CALL THEM CIGA-LIKE BECAUSE THEY LOOKED VERY MUCH LIKE A CIGARETTE, THOUGH THERE ARE DIFFERENT COLOR, THEY HAD A SIMILAR SHAPE.

THOSE HAVE EVOLVED FROM THE CIGA-LIKE TO THIS, WHICH IS MORE COMMONLY THOUGHT OF AS A VAPED 10.

AND THE THING THAT I WANT TO CALL YOUR ATTENTION TO IS THAT YOU CAN PUT YOUR OWN E-LIQUID IN THIS AS WELL AS OTHER SUBSTANCES, PARTICULARLY IN YOUTH.

WE KNOW THAT YOUTH ARE ADDING THINGS LIKE THC, OTHERWISE KNOWN AS MARIJUANA, OTHER ILLEGAL SUBSTANCES.

SO EVOLVED FROM THESE VAPED PENCE TO THIS IS SOMETHING CALLED A MOD OR A TANK SYSTEM.

AS YOU CAN SEE, THEY ARE BIGGER.

THEY DON'T LOOK LIKE CIGARETTES ANYMORE.

THEY HAVE A LARGE OR REFILLABLE CONTAINER FOR THE E-LIQUID.

THEN YOU CAN ALSO ADJUST THE VOLTAGE IN THE WATTAGE.

USERS FEEL THAT THEY HAVE A MORE INDIVIDUALIZED EXPERIENCE.

AND THEN WHAT OUR YOUTH ARE PRIMARILY USING THESE PRODUCTS KNOWN AS JUUL.

AND JUUL, WE WILL SAY IT'S LIKE THE iPhone OF E CIGARETTES, THAT TECHNOLOGY IS VERY ADVANCED.

THEY ARE WHAT WE CALL POD SYSTEMS.

AND SO, THE JUUL DEVICE HAS THESE PODS THAT YOU PUT IN THE DEVICE, AND THEN YOU VAPED.

EACH POD HAS AS MUCH NICOTINE AS A PACK OF CIGARETTES.

AND SO, THAT IS REALLY THE THIRD MAIN EVOLUTION IN E CIGARETTES, IS THAT THIS ACTUAL LIQUID HAS CHANGED QUITE A BIG DEAL, AND ONE OF THE WAYS IT'S CHANGED IS THAT IT CONTAINS NICOTINE SALTS.

AND SO, THE E-LIQUID, WHICH COMES IN, YOU KNOW, CANDY FLAVORS LIKE THIS CANDY CANE WHICH CERTAINLY LOOKS LIKE SOUR PATCH KIDS, THEY ARE ABLE TO PUT A VERY HIGH AMOUNT OF NICOTINE.

AND WHAT THAT DOES PARTICULARLY WITH OUR YOUTH IS IT IS THE POTENTIAL FOR HIGHER LEVELS OF ADDICTION.

THE FOOD AND DRUG ADMINISTRATION, THE FDA, HAS REGULATORY AUTHORITY OVER TOBACCO PRODUCTS.

THEY DO HAVE REGULATORY AUTHORITY WITH SOMETHING CALLED THE DEEMING ROLE WHICH WAS IMPLEMENTED IN 2016.

5.3 MILLION, MILLION HIGH SCHOOL AND MIDDLE SCHOOL STUDENTS WHO ARE USING E CIGARETTES, MANY OF THOSE STUDENTS WOULD HAVE NEVER PICKED UP A CONVENTIONAL CIGARETTE.

IN ADULTS THAT ARE TRYING TO QUIT USING CIGARETTES, UNFORTUNATELY, THE STUDIES ARE SHOWING THAT IN NORMAL SITUATIONS, THEY ARE MORE LIKELY, THEY ARE MORE LIKELY TO USE BOTH THE E-CIGARETTE AND THE REGULAR CIGARETTE.

SO THEY ARE KNOWN AS JUUL USERS.

INSTEAD OF BEING ABLE TO QUIT CIGARETTES, THEY END UP JUST PICKING UP E CIGARETTES ON TOP OF THAT.

SO THE META-ANNOUNCEMENTS BY STAN GLANTZ SHOWS CIGARETTE USERS WHO USE E CIGARETTES TO QUIT ARE ACTUALLY LESS LIKELY TO QUIT CIGARETTES.

IN FACT, WHAT HAPPENS IS THAT E CIGARETTES POTENTIATE WHERE THEY CONTINUE THE NICOTINE ADDICTION.

>> LET'S MOVE ON A BIT AND TALK ABOUT VAPING AND TOBACCO AND COVID-19.

>> THERE HAS BEEN A RECENT META-ANALYSIS, SO IT'S BASICALLY A SUMMARY OF 19 DIFFERENT STUDIES THAT LOOKED AT PATIENTS WHO HAD COVID-19 AND THAT ALSO HAD A HISTORY WAS TAKEN OF THEIR SMOKING STATUS.

AND WHAT THEY FOUND IS THAT SMOKERS WERE TWICE AS LIKELY WITH AN ODDS RATIO OF 1.9, SO ALMOST TWICE AS LIKELY, OF DEVELOPING SEVERE COVID-19 SYMPTOMS.

>> WELL, WE HAVE NOT SEEN AS MANY TEENAGERS ACTUALLY CONTRACTING THE DISEASE.

THEY SEEM TO BE LESS LIKELY TO SOCIAL DISTANCE, THEY ARE MORE LIKELY TO BE PICKING UP BAD HABITS LIKE VAPING.

WHAT KIND OF A PUBLIC HEALTH MESSAGE NEEDS TO GO OUT TO THAT POPULATION?

>> WE KNOW THAT 27 PERCENT OF HIGH SCHOOL STUDENTS FROM 2019 DATA FROM THE NATIONAL YOUTH TOBACCO SURVEY OUR CURRENT USERS OF E CIGARETTES.

AND, YOU KNOW, WITH THIS PANDEMIC, WE DON'T KNOW WHAT DIRECTION THAT IS GOING TO TAKE.

WE KNOW THAT THAT NUMBER HAS RISEN ASTRONOMICALLY SINCE THE NATIONAL YOUTH TOBACCO SURVEY STARTED SURVEYING FOR E CIGARETTES IN 2011 WITH SOCIAL ISOLATION AND ANXIETY AND STRESS.

YOU KNOW, CERTAINLY PEDIATRICIANS LIKE MYSELF WORRY THAT THAT NUMBER, THERE MAY BE AN INCREASE IN STUDENTS USING VAPED PRODUCTS OR OTHER TOBACCO PRODUCTS.

>> THAT BRINGS UP AN INTERESTING POINT, BECAUSE IF PEOPLE OR IF ADULTS ARE VAPING OR SMOKING NEAR CHILDREN, DOES THAT CREATE MORE OF A PROBLEM FOR THE CHILDREN IF THEY GET COVID-19 FOR THEIR HARD AND LUNGS AND JUST GENERAL RESPIRATORY HEALTH?

>> THAT IS ABSOLUTELY A GREAT QUESTION.

AND AT THIS POINT, WE HAVE BASICALLY NO DATA ON SECONDHAND SMOKE AND THE EFFECTS ON CHILDREN RELATED TO COVID-19.

WHAT WE CAN SAY, THOUGH, IS THAT SECONDHAND SMOKE IS A BIG RISK FACTOR FOR CHILDHOOD ILLNESSES.

WE KNOW THAT SECONDHAND SMOKE INCREASES THE RATE OF SUDDEN INFANT DEATH SYNDROME, SINCE HER CRIB DEATH.

WINDOW IT INCREASES EAR INFECTIONS, PNEUMONIA, ASTHMA, ASTHMA ATTACKS, BRONCHIOLITIS, WHICH IS ANOTHER DISEASE, ANOTHER ILLNESS THAT IS CAUSED BY DIFFERENT VIRUSES.

SO I THINK IT IS VERY SAFE TO SAY THAT SECONDHAND SMOKE IS BAD FOR DEVELOPING LUNGS, FOR CHILDHOOD LUNGS AND ADULT LUNGS.

BUT WE CANNOT SAY WHAT SECONDHAND SMOKE OR SECONDHAND VAPED IS DOING IN TERMS OF COVID-19.

>> Bonnie: THAT'S IT FOR THIS EDITION.

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