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By Anne Blythe

As North Carolina Attorney General Josh Stein briefed media about the lawsuit he filed against Juul Labs, the multi-billion dollar e-cigarette giant, a High Point teenager and his mother stood at the podium, too.

Luka Kinard was a 15-year-old high school freshman when he started vaping, first inhaling the flavored nicotine at a high school football game as a way to fit in.

As Luka became, by his description, the go-to-guy for other students to vape with, his mother Kelly Kinard became more and more troubled by a pendulum swing in his behavior.

His grades plunged.

His weight dropped.

He lost interest in Boy Scouts, sports, fishing and other activities that previously brought him joy. His anger became explosive.

Luka is 16 now, back in high school, much healthier and sharing his experiences so other teens can better understand the nicotine addiction that sent him spiraling so out of control his mother sent him to a California substance abuse treatment center for more than a month.

“I did not send my 15-year-old to residential treatment in California for 39 days because he was caught smoking or even just vaping,” his mother said during the news conference broadcast on Facebook last week. “I sent him because he had a substance abuse problem. The substance was Juul.”

Luka Kinard speaks at Attorney General Josh Stein’s press conference announcing his lawsuit against Juul. Photo credit: NC Department of Justice and Attorney General’s Office Facebook page

Kelly Kinard has been retelling her son’s story, too, in the Wall Street Journal, other media outlets and auditoriums across the state not only as a cautionary tale but to highlight her struggle to get counselors, doctors and others to recognize his nicotine addiction as a substance abuse problem that needed more specialized care than being offered.

“Our son needed treatment that didn’t exist,” she told reporters at Stein’s news conference on Wednesday, “and we didn’t have time for research to catch up.”

What’s with the flavor?

Stein is the first state attorney general in the country to sue Juul, though the parents of children who suffered ill effects from the nicotine pods and adults seeking class-action status have taken legal action across the country against the company.

Even as the lawsuits wend their way through the courts, researchers are racing to explore not only the nicotine effects but the short- and long-term impacts of the products.

Much research is going on across the country and here in North Carolina on e-cigarettes and vaping.

Research at UNC-Chapel Hill and Duke has shown that flavors added to the nicotine pods, such as cinnamon, vanilla, cherry and citrus, can have harmful effects on the lungs.

E-cigarettes contain solutions of nicotine, flavorings and other chemicals that are heated into a vapor that users inhale much as they would a combustible cigarette.

Pediatric microbiologist and immunologist Ilona Jaspers (r) has been studying the effects of flavorants in vaping liquids. Photo courtesy: UNC Chapel Hill

The products were released onto the market a little more than a decade ago purportedly as safer alternatives to traditional cigarettes, but researchers have limited data on long-term effects of vaping.

Ilona Jaspers, director of the UNC-Chapel Hill public health school’s  toxicology program, cautions against starting with a baseline that compares e-cigarettes to combustible cigarettes. Instead, she suggests looking at what people are inhaling and compare the research results to what is seen in someone who has not used those products.

“The bottom line is e-cigarettes are not without health effects,” Jaspers, also deputy director of the UNC Center for Environmental Medicine Asthma and Lung Biology, said in a telephone interview.

Jaspers and her researchers have been studying the effects of flavored e-liquids, readily available at vape shops, on lung cells and their findings about a cinnamaldehyde, an organic compound that gives cinnamon its distinct taste and aroma. Their results were widely publicized last summer.

Though the additive is broadly considered safe when put in and ingested in food, the UNC-CH researchers found that in vaporized form it impaired the cilia, or small hairlike structures important for clearing mucus and pathogens from the airways, in a human lung they studied.

“The flavors are a big unknown,” Jaspers said.

As researchers continue to mine the new products being pushed into the market, others are looking to the courts for answers.

The courts play a role

The same day that Stein announced his lawsuit against Juul, a federal judge ruled in favor of the American Academy of Pediatrics, Campaign for Tobacco-Free Kids and other groups that sued the Food and Drug Administration for its lack of oversight and regulation of the thousands of e-cigarettes on the U.S. market.

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

The federal lawsuit challenged an FDA decision in 2017 to extend deadlines by five years for e-cigarette manufacturers seeking the agency’s approval for products that went on the market after 2007.

In announcing their lawsuit in 2018, the organizations pointed to Juul, the largest e-cigarette brand on the market, as a reason for swift FDA oversight and regulation.

The company’s e-cigarette is the size of a flash-drive and because of the similarities, some schools have banned flash drives in an attempt to rein in Juuling, the verb teens sometimes use to describe their use of the devices.

The lawsuit filed by Stein in Durham County Superior Court contends that “Juul has played a central role in fostering the epidemic of e-cigarette use among youth.”

In the past year, the suit claims, Juul’s share of the e-cigarette market has climbed to 75 percent from 24 percent.

“Juul has long claimed that its e-cigarettes are intended only for adult smokers seeking to transition away from traditional cigarettes, even though it has not sought nor has the FDA granted a designation as an approved smoking cessation device,” the lawsuit further contends. “But the facts tell a very different — and sobering — story: teens aged 15 to 17 are far more likely to use Juul than Juul’s supposed target demographic of 25- to 34-year-olds.”

“How does Juul target young people?” Stein said at the news conference. “It uses fruit and dessert-like flavors to entice children to the product.”

Not only did the company use marketing strategies targeting middle-school and high school students too young to legally buy its products, it minimized “the potency and danger of the nicotine in its e-cigarettes,” the lawsuit contends.

The North Carolina Youth Tobacco Survey, which collects responses from students in public school in grades 6-12, found that in 2017 nearly 17 percent of all high school students—and more than 5 percent of all middle-schoolers — reported using an e-cigarette within the previous 30 days.

Stein hopes to persuade the court to order Juul to stop selling to, marketing to and distributing its products to young people in North Carolina.

“Juul created and spread a disease,” Stein said, “the disease of addiction among North Carolina teenagers.”

Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.

One reply on “As NC attorney general tries to slow Juul use among NC teens, researchers weigh health effects of e-cigarettes”

  1. And NC is the largest producer of tobacco in the nation. Nah, no special interests here.

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