Generation Vape: As Juul faces new suit, doctors worry over epidemic of e-cigarette-related student illnesses

BRONX, N.Y. – New York state is suing the nation's biggest e-cigarette maker, Juul Labs, alleging the San Francisco-based company used deceptive and misleading marketing to target teenagers and failed to warn them of the harmful health effects associated with its products.

“Juul took a page from Big Tobacco’s playbook by engaging in deceptive business practices when marketing and advertising its products, and illegally sold its products to minors through its website and in third-party retail stores throughout the state, causing large numbers of New York youth to become addicted to nicotine," the lawsuit filed Tuesday in New York County Supreme Court read.

The complaint -- filed one day after California sued Juul Labs -- was the latest clash with a company that doctors and lawmakers claimed has been largely to blame for a national youth vaping epidemic that has triggered at least 42 deaths and 2,172 illnesses directly related to e-cigarette use.

Gov. Andrew Cuomo, D-N.Y., signed a bill this past July raising the age to 21 for anyone wishing to buy tobacco or electronic-cigarette products, and the bill went into effect Nov. 13. But, the demand for Juul products -- small e-cigarettes known for their high nicotine content -- has been greater than ever among high school and college-aged students.

On a recent fall afternoon, outside the main gates of Fordham University’s Bronx campus, Dylan, a 19-year-old college sophomore, made a stop at a bodega after class for his daily purchase – a soda, sandwich and a pack of mint-flavored Juul pods.

“You see it everywhere. Outside college dorms and campuses, they’re like cockroaches,” he said of the discarded pods and wrappers that littered the on- and off-campus sidewalks and street corners.

Dylan’s experience was not unusual. He’s been part of a growing number of underage people across the country whose habitual use of vape products has presented a serious health concern, according to several doctors interviewed by Fox News.

The legal age to buy e-cigarette and vape products is 18 years old in 28 states. In 18 states and the District of Columbia, the required age is 21. The minimum legal age to buy them in four states -- Alabama, Alaska, Nebraska and Utah -- is 19, though Utah has signaled plans to raise the age to 21 by July 2021.

In accordance with New York state law, Fordham University has prohibited smoking inside all campus buildings. E-cigarettes also were not permitted within 50 feet of “the entrances or exits of any university-owned or leased on-campus and off-campus buildings and facilities,” according to the school.

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“Violation of this policy may subject students to university sanctions and other fines,” Fordham spokesman Bob Howe told Fox News. In addition, Howe said the school would notify the New York City Police Department when it learned of off-campus violations related to the sale of tobacco and vaping products.

Despite Fordham’s written policy, Juul use on campus has been widespread. Fox News interviewed seven students, all of whom said they used Juul and frequently reported seeing others smoke the product in many places on and off the Fordham campus.

“If I’m hanging out with one of my friends and they have one, I want to use it,” said one freshman student, identified as Calvin. “You’re basically always hanging out with people so that temptation is always there.”

Erica, a senior and former Juul user, referred to Juul’s many flavors as if they were candy. “Mint is by far the most popular flavor,” she told Fox News. Days later, on Nov. 7, Juul announced it was stopping the sale of mint-flavored pods following the widely reported 2019 National Youth Tobacco Survey that found mint was one of the most used flavors among high school students.

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E-cigarette use has been amplified in social situations. Students have claimed they’ve been easily accessible to all, and one Juul often would be shared among multiple people.

Michael, a senior, said he preferred to “mooch” off others rather than buying his own Juul, he said. This would save money, considering a pack of four Juul cost $15.99, and the device itself, which includes a charger, cost $14.99. Juul products often have been sold more at off-campus bodegas.

Juul pods – the most common of the e-cigarettes among young people – vary in the amount of nicotine they contain. Some pods, for instance, contain 5 percent of nicotine versus others that have 3 percent. Consumers can buy a pack of two or four pods, and the nicotine in each pod is equivalent to that in a pack of 20 cigarettes, according to the manufacturer.

The Centers for Disease Control and Prevention (CDC) recently reported that vitamin E acetate could be the culprit behind a “multistate outbreak” of “e-cigarette, or vaping, product use associated lung injury,” otherwise known as EVALI.

“This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries,” CDC officials said in a Nov. 8 news release.

The CDC announced it “continues to recommend that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers.” THC is the chief psychoactive compound in marijuana.

Several doctors interviewed by Fox News expressed serious concerns over the long-term use of e-cigarettes, especially among young people.

“We know that nicotine can affect the developing brain,” said Dr. Jen Caudle, a family physician and associate professor at Rowan University.

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“We don’t know fully [the extent], but we know things like attention and memory,” could be affected, she said. “I’ve seen young people have side effects and withdrawal symptoms as a result of vaping nicotine.”

Dr. Melodi Pirzada, a pediatric pulmonologist at NYU Winthrop Hospital who was among the first doctors to treat a vaping-related injury, emphasized the highly addictive nature of e-cigarettes.

“E-cigarettes, if they are with nicotine, are very addictive,” Pirzada told Fox News, “because nicotine is the third most addictive substance in the United States, [along with] cocaine.”

She added, “From an older generation, we know that cigarette smoking cessation has been very difficult. Now, the e-cigarettes with nicotine are a huge problem, a big addictive tool.”

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Pirzada reported a slew of health issues directly linked to e-cigarette use: coughing; back, shoulder and chest pain; fever; shortness of breath; and digestive problems such as nausea and vomiting.

Caudle, Pirzada and Dr. Peter Shields, deputy director of the Comprehensive Cancer Center at the Ohio State University Medical Center, all stated that e-cigarettes have been pervasive among high school and college students.

“Unfortunately it is on such a rise because this is the most ‘in’ thing now among teenagers,” Pirzada said.

While most underage students would hide the habit from their parents, Rebecca, a college junior, said she told her mother because she needed help to fight her addiction.

“I confessed to her because I wanted her to control me more,” she said.

“It’s really hard to go cold turkey – almost impossible,” Rebecca continued. “I just have these cravings.”

She added, “When I smoke cigarettes, I usually smoke two to three a day. With Juul, I smoke a whole Juul pod a day, which is like 20 cigarettes. It’s such a big difference.”

Juul, for its part, did not condone underage use of its products. In a statement to Fox News, a Juul Labs spokesperson said: “Juul Labs exists to give adult smokers an alternative to combustible cigarettes, and we don't want any non-nicotine users of any age to use Juul products.”

The statement continued, “We are focusing on reducing underage usage, investing in scientific research, developing technology to curb underage access.”

Parents and doctors, however, have claimed that Juul intentionally has marketed its products for young adults and teenagers without warning them of the potential health risks, despite the company’s statements to the contrary.

Those claims have led to the first wrongful death lawsuit. Juul was sued this past October by a Florida mother who blamed the vape company for her son’s death. According to the suit, 18-year-old Daniel Wakefield, who was addicted to Juul and had been hospitalized three times for respiratory complications, died in his sleep from breathing problems in August 2018.

Some of the students interviewed by Fox News said they considered these stories to be cautionary tales and encouraged others to refrain from using e-cigarettes.

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“Don’t do it,” said Calvin. “Most people who do it wish that they never did.”

EDITOR’S NOTE: The underage college students interviewed by Fox News spoke on condition of anonymity and their names were changed in this report to protect their identities.