By Anne Blythe

Duke University, a college campus with deep roots in tobacco money, is set to go smoke-free this summer, but it’s more than tobacco products that will be banned.

Administrators announced in an email to students earlier this month that e-cigarettes and vaping products will be included in the ban, too.

The smoke and vape-free policy, scheduled to take effect on July 1, has been two years in the making. It will apply to all property and facilities owned or rented by Duke.

“After extensive consultation with students, faculty and staff, as well as with clinical experts, Duke will expand the policy to include all tobacco products, including all electronic smoking devices such as e-cigarettes and vaping products, cigarettes, cigars, hookah, chewing tobacco, snuff, IQOS, and all other forms of tobacco.” That was part of the nine-paragraph email distributed to students, faculty and staff earlier this month, signed by Eugene Washington, chancellor for Health Affairs and president and CEO of the Duke University Health System, and Kyle Cavanaugh, Duke vice president of administration.

There has been much debate over the past six months about whether Duke should include the electronic smoking devices in the policy born out of the Healthy Duke Initiative being led by Washington and Cavanaugh.

The Duke Chronicle, the campus student newspaper, followed much of the back and forth from student government and faculty council meetings, as well as pushback from Jed Rose, director of the Duke Center for Smoking Cessation and a professor in psychiatry and behavioral sciences.

Lung injury scares

The announcement and decision to ban electronic smoking devices comes as universities across the country wrestle with how to react to a growing epidemic — the alarming increase of nicotine use among teens who have embraced vaping products despite potential health risks and many unknowns associated with the flavored pods and sleek devices.

shows bronze statue of a man leaning on a cane, smoking a tobacco product
The statue of James Buchanan Duke at Duke University in Durham, features the university founder holding a cigar. Photo credit: Ildar Sagdejev, Wikimedia Commons

Texas A&M University and the California State University system already have banned the products, according to Inside Higher Ed. The State University of New York has pushed for the past eight years for laws requiring tobacco-free campuses and suggested adding e-cigarettes to any legislation instituting the bans, as well.

E-cigarettes and vape pens were introduced as potential antidotes or substitutes for adult smokers trying to give up cigarettes, cigars and other combustible tobacco products.

But for much of the past year, public health officials, the Centers for Disease Control and Prevention and others have had to grapple with mysterious vaping-related lung injuries and deaths.

The CDC reports a total of 2,758 cases between August and early February in which people have been hospitalized with injuries related to e-cigarettes and vaping devices. Sixty-four deaths have been confirmed in 28 states and the District of Columbia as of Feb. 4.

Researchers have zeroed in on vitamin E acetate used to thicken the vaping liquids. The substance cuts down on the amount of nicotine or marijuana extract oil needed in some of the counterfeit online brands or street products and has been identified as the likely culprit.

In addition, public health advocates continue to caution that there are more unknowns about the long-term effects of the flavored liquids and other vaping devices as researchers scramble to study the new products and weigh any benefits and risks.

In their message to Duke students, faculty and staff, Washington and Cavanaugh mentioned EVALI, the term coined by the CDC last year after a spate of e-cigarette or vaping product use-associated injury emerged in many states.

As of Feb. 6, 77 cases of EVALI had been reported in North Carolina with no deaths reported here.

“This syndrome causes severe and sometimes fatal lung injury and commonly affects young people who are otherwise healthy,” the Duke administrators noted.

That’s why, they said, that they decided to add vaping products to the smoking-free campus policy.

“Combined with the rapid increase of vaping and use of e-cigarettes in recent years, especially among college-age students, we have reconsidered these provisions of the policy,” the administrators added.

NC out of sync with country

In December, the U.S. Congress, under mounting pressure about teenage vaping, passed a provision in a spending package signed by President Donald Trump that bans the sale of e-cigarettes and tobacco to anyone under 21.

North Carolina law prohibits the sale of tobacco products to anyone under 18. E-cigarettes and the sale and distribution of “vapor products” to anyone under 18 are also prohibited.

Last year, North Carolina Attorney General Josh Stein filed a lawsuit last year against e-cigarette giant Juul, hoping to persuade a Durham County Superior Court judge to order the company to stop marketing to, selling to and distributing its products to young people across the state.

He was the first state attorney general in the country to file suit against the company that, according to his lawsuit, used marketing strategies that not only targeted high school students but middle-school students as well.

Though the case has yet to make its way to trial, a Juul spokesperson said at the time that the company shared Stein’s concerns about youth vaping and was strongly advocating for “T21 legislation,” shorthand for tobacco laws to raise the purchase age to 21.

Mandy Cohen, secretary of the state Department of  Health and Human Services, told North Carolina lawmakers recently at a meeting of the Joint Legislative Committee on Health and Human Services, that she hoped to make the smoking and vaping laws a topic of discussion before the lawmakers are scheduled to go back into session in late April.

“As you know the federal government did raise the age to 21,” Cohen reminded lawmakers on Feb. 11. “Our state law says 18 so we’re in the process of needing to work with you all to figure out how to update that.”

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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.

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