pictures the Juul nicotine delivery system. The next generation in e-cigarettes
The Juul nicotine delivery device with it's USB charger and "pods" filled with nicotine liquid. The devices have proven hugely popular with teens. Photo credit: Rose Hoban

By Rose Hoban

Six years after North Carolina legislators eliminated funding for teen tobacco cessation programs, health officials are noting a sharp uptick in the number of kids using nicotine products.

While the percent of high school students smoking cigarettes is at a historic low in the past four years, researchers from the Tobacco Prevention and Control Branch of the state Department of Health and Human Services have tracked a steady and increasingly steep climb in the number of kids using e-cigarettes.

In a presentation to the legislative Child Fatality Task Force on Tuesday, Jim Martin, from the Tobacco Prevention and Control Branch, described how only 9.3 percent of high-school aged teens reported they smoked a cigarette in the past 30 days in 2015, but when asked if they used “any” tobacco product, the percentage of users jumped to 27.6 percent among the same group.

shows trendlines in smoking, in spending and in the use of new nicotine delivery devices
Martin noted that since 2001, North Carolina has received $149 million, on average, from the tobacco industry as part of the 1999 Master Settlement Agreement. The money was originally supposed to mitigate the harms created by tobacco and the economic challenges created by the sunsetting of the tobacco industry. Graph courtesy: Tobacco Control and Prevention Branch, NC DHHS

Martin said that he fears the data from the 2017 Youth Tobacco Survey, which he said is due for release in March or early April, will reveal more bad news. He expects the numbers to show a significant increase in e-cigarette, or vaping, use.

And Martin said that many students are reporting use of a recently introduced product, the Juul e-cigarette.

“‘It just blew up over the summer,’” Martin reports kids as telling him. “And this is the summer of 2017 that they’re talking about.”

Stealthy substitute

Martin said that the Juul’s sleek appearance and innocuous design has allowed the product to fly under the radar.

The product, black and about 3.5 inches long and about the width of a USB drive, is discreet. He said the high-tech design has led some to compare Juuls to the “Apple of vaping.”

“These can be disguised and brought to school,” he said. “Teachers will think they’re a flash drive, and kids easily can hold them in a coat pocket and use them between classes, even during class, when the teacher is unaware.”

shows an uptick in spending on advertising corresponding with uptick in teen nicotine and tobacco use
Graph courtesy: Tobacco Control and Prevention Branch, NC DHHS

And Juuls pack a punch. The liquid in the small “pods” contains 5 percent nicotine and is good for about 200 puffs or about the same as a pack of cigarettes.

“That’s a large percent of nicotine that’s actually a higher percent than is in a lot of e-liquids that are sold in shops,” Martin said.

He also said that the formulation used in the liquid is of nicotine salts, that mask the harshness of nicotine traditionally delivered by a cigarette.

“You have kids describing it as a very smooth hit,” he said.


The product was only introduced in 2015, but last year, the product’s popularity exploded. Juul controlled a quarter of the market share in early September 2017, according to Nielsen By the end of last month, Juuls accounted for fully half of the e-cigarette market.


Martin said he’s discouraged that funding was pulled just as so much progress was being made to dissuade kids from starting to use tobacco. Before 2013, when the state budget was zeroed out, North Carolina spent about $17 million a year on a program that was a national model at helping kids think critically about tobacco, nicotine and smoking.

The result was a steady drop in use by teens, which seems to have bottomed out in 2013, around the time vaping started to gain popularity.

shows that while 9.3 percent of teens report using cigarettes in the survey, 16.3 percent report using an e-cigarette and other nicotine delivery devices
Results from the 2015 Youth Tobacco Survey show more kids using nicotine delivery devices such as e-cigarettes than use traditional cigarettes. Graph courtesy: Tobacco Control and Prevention Branch, NC DHHS

Now, despite North Carolina receiving about $149 million funds per year from the 1999 tobacco company master settlement agreement, the state spends a little over a million annually on tobacco cessation.

“With the reduction in funding at the same time as these new e-nicotine delivery devices … that’s been a perfect storm where we’ve seen decreases in funding with increases in overall tobacco use in our teen population,” Martin said.

Proponents of vaping argue that the practice is less harmful than smoking and can be a bridge to quitting, or at least reducing harm for people who smoke cigarettes, an argument that was bolstered by a 2015 British review showing that the devices could help people quit.

But that’s not the point, argued Martin who noted that research shows 90 percent of tobacco users started before the age of 18. And research seems to indicate that using e-cigarettes may encourage, rather than discourage, the use of conventional cigarettes among adolescents , creating habitual users, who will be new customers for tobacco companies in the coming decades.

He also showed results from studies being conducted at several labs at UNC-Chapel Hill where researchers are exposing lung cells to the propylene glycol and glycerin solutions contained in e-cigarette liquids.

“You see a cause and effect where the exposures lead to cell loss and cell viability and out to cell death,” Martin said. “These are the first markers for disease.”

An exhaustive literature review conducted by the American Academy of Pediatrics Committee on Substance Use and Prevention and published early in 2017 found that the use of nicotine alone can, over time, create changes in brain chemistry and architecture, especially in developing brains.

The review also noted nicotine use has been found to increase the presence of stress hormones in the body and disrupt the sleep-wake cycle, as well as contribute to diseases in many body systems.

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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