Thousands of North Carolina teens and young adults have taken part in programs in the past year that are aimed at helping them to quit vaping or to prevent them from starting.

Funding for the programs comes from a $40 million settlement the state won in 2021 against e-cigarette maker Juul. In December, Attorney General Josh Stein announced that Juul would pay another $7.8 million to the state.

Stein, who is the Democratic nominee in the upcoming governor’s race, sued Juul in 2019 over its role in growing nicotine use among the state’s youth. More teens use e-cigarettes than regular cigarettes, according to the latest state Youth Tobacco Survey in 2022.

The $40 million paid by Juul when they settled the case will pay for e-cigarette cessation and prevention programs, data monitoring, evaluation of programs, a documents depository and litigation costs.

In January, Stein announced the launch of a searchable database of Juul documents that can be used by the public and researchers. The depository will be housed by UNC Chapel Hill’s University Libraries and the University of California-San Francisco, which houses a similar database about legacy tobacco companies.

The state is in the first full year of spending money from the settlement, said Adam Goldstein, director of Tobacco Intervention Programs at the UNC School of Medicine, which received $887,431 in Juul settlement funds for a two-year contract to research e-cigarette use among the state’s youth and young adults.

“They’re doing a really good job of trying to design a comprehensive program,” Goldstein said of the state’s efforts so far. “I’m proud of that work. I’m happy we’re in a state that’s willing to do that.”

It’s too early to see if those efforts have paid off.

“What we do know is that [vaping] continues to be a problem, which we know because of our ongoing work,” he said.

Tobacco use among youth

In North Carolina, one in eight high school students uses a tobacco product, according to the Youth Tobacco Survey. That is equal to three students in every classroom.

Nationally, e-cigarettes took over as the No. 1 tobacco product for youth in 2014 after years of decline in the use of traditional cigarettes. E-cigarettes remain the favored product today, including in North Carolina.

E-cigarettes, or electronic cigarettes, are also called by other names, such as vape pens, e-hookahs and mods. Most have a battery, a heating element and a place to hold liquid. When the liquid is heated, users inhale the vapors, which carry nicotine and other additives or flavors.

The state Youth Tobacco Survey showed that overall, about 57,300 high school students and 18,600 middle school students currently use tobacco products. Nearly three in 10 high school students and five in 10 middle school students reported they use more than one type.

Cigarettes are the third most popular tobacco product among the state’s youth. Cigars, cigarillos and little cigars come in second, according to the survey.

E-cigarettes — the top product — are used by 43,800 high school students and 12,500 middle school students in North Carolina.

Nearly 91 percent of high school students and 95.6 percent of middle school students in the state who are current users report using flavored e-cigarettes.

Enticing flavors

The Juul e-cigarette first entered the market in 2015. At its height, Juul claimed about 75 percent of the e-cigarette market share in the United States. By last year, Juul’s share had dropped to 24.4 percent.

At the same time, e-cigarette sales continued to grow as other players entered the market. Sales nearly tripled from 7.7 million units in a four-week period in 2014 to 22.7 million in a four-week period in 2022, according to reports by the Centers for Disease Control and Prevention.

More recently, Elf Bar has become a favorite brand among youth. More than half of middle and high school students who vape used an Elf Bar product in the past 30 days, according to the 2023 National Youth Tobacco Survey.

Elf Bar offers such exotic flavors as citrus sunrise, nana coconut and watermelon ice. None have been approved for sale in the U.S.