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January 27, 2020

Analysis of the vapor industry in North Carolina, including economic data, state health department findings on vaping-related lung illnesses, youth e-cigarette use, tobacco retail compliance checks, and state funding dedicated to tobacco control programs.

PTS-North Carolina: News

Since their introduction to the U.S. market in 2007, e-cigarettes and vaping devices—tobacco harm reduction products that are 95 percent safer than combustible cigarettes—have helped more than three million American adults quit smoking.

1. Economic Impact
According to the Vapor Technology Association, in 2018, the industry created 3,645 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in North Carolina, which generated $106 million in wages alone.[1] Moreover, the industry has created hundreds of secondary jobs in the Tar Heel State, bringing the total economic impact in 2018 to $801,218,900. In the same year, North Carolina received more than $44 million in state taxes attributable to the vaping industry. These figures do not include sales in convenience stores, which sell vapor products including disposables and prefilled cartridges. In 2016, sales of these products in North Carolina eclipsed $16.5 million.[2]

2. State Health Department Data
As of January 23, 2020, the North Carolina Department of Health and Human Services (NCDHHS) has reported 76 cases of vaping-related lung illnesses in North Carolina.[3] The age of patients ranges from 13 to 72 years-old, with a median age of 25 years. To date, 64 percent of patients are male. NCDHHS interviewed a subgroup of 20 patients, with 80 percent reporting to have used vapor products containing tetrahydrocannabinol (THC). The Heartland Institute gives NCDHHS a grade of C for information available on vaping-related lung illnesses.

3. More Information Needed
The most recent report on youth e-cigarette use in North Carolina is from the 2017 North Carolina Youth Risk Behavior Survey.[4] According to the survey, in 2017, only 3 percent of North Carolina high school students reported current daily e-cigarette use. Further, according to the 2017 North Carolina Youth Tobacco Survey, only “1 in 4” North Carolina high school students cited “flavors” as a reason to use vapor products.[5] More data is needed to understand the effects of public health campaigns on youth e-cigarette use.  

4. Youth Sales Miniscule
From January 1, 2018 to September 30, 2019, the U.S. Food and Drug Administration (FDA) administered 5,409 tobacco age compliance inspections in North Carolina, in which the agency used a minor in an attempt to purchase tobacco products.[6] Of those, 1,433 or 26 percent, resulted in a sale to a minor. Of the violations, 582 (10 percent of all compliance checks) involved the sale of e-cigarettes or vaping devices. The number of violations involving sales of cigars and cigarettes were 648 and 173, respectively, during the same period.

5. Misspent Money
In 2019, North Carolina received an estimated $450.4 million in tobacco taxes and tobacco settlement payments. In the same year, the state spent $1 million, or less than 1 percent, on funding tobacco control programs, including education and prevention.[7]

Policy Solution
Electronic cigarettes and vaping devices have proven to be tremendous tobacco harm reduction tools, helping many smokers transition away from combustible cigarettes. Despite recent fearmongering, their use is significantly safer than traditional cigarettes, as noted by numerous public health groups including the Royal College of Physicians,[8] Public Health England,[9] and the American Cancer Society.[10] Rather than restricting their use, and undoubtedly reducing public health gains and millions of dollars in economic output, lawmakers should dedicate existing tobacco funds on programs that actually reduce youth use.

Key Points:

1. North Carolina’s vaping industry provided more than $801 million in economic activity in 2018 while generating 3,645 direct vaping-related jobs. Sales of disposables and prefilled cartridges in North Carolina exceeded $16.5 million in 2016.

2. As of January 23, 2020, NCDHHHS has reported 76 cases of vaping-related lung injuries. An earlier report on a subset of cases noted that 80 percent of patients reported vaping THC. NCDHHS earns a C for its transparency on vaping-related lung illnesses.  

3. In 2017, only 3 percent of North Carolina high school students reported daily e-cigarette use, only a quarter cited using vapor products because of flavors. More data is needed.   

4. Only 10 percent of FDA retail compliance checks in North Carolina resulted in sales of e-cigarettes to minors from January 1, 2018 to September 30, 2019.

5. North Carolina spends very little on tobacco prevention. In 2019, North Carolina dedicated only $2.4 million to tobacco control programs including education and prevention, or less than 1 percent of what the state received in tobacco settlement payments and taxes.


[1] Vapor Technology Association, “The Economic Impact of the Vapor Industry NORTH CAROLINA,” 2019,

[2] Teresa W. Wang et al., “National and State-Specific Unit Sales and Prices for Electronic Cigarettes, United States, 2012-2016,” Preventing Chronic Disease, Centers for Disease Control and Prevention, August 2, 2018,

[3] Tobacco Prevention and Control Branch, “North Carolina E-cigarette, or Vaping, Product Use Associated Lung Injury Data,” North Carolina Department of Health and Human Services, January 23, 2020,

[4] Centers for Disease Control and Prevention, “High School YRBS North Carolina,” 2017,

[5] North Carolina Public Health, “North Carolina Youth Tobacco Survey(NC YTS) Middle & High School Fact Sheet,” 2017,

[6] U.S. Food and Drug Administration, “Compliance Check Inspections of Tobacco Product Retailers,” September 30, 2019,

[7] Truth Initiative, “Tobacco use in North Carolina,” June 28, 2019,

[8] Royal College of Physicians, Nicotine without Smoke: Tobacco Harm Reduction, April 2016,

[9] A. McNeill et al., “Evidence review of e-cigarettes and heated tobacco products 2018,” Public Health England, February 2018,

[10] The American Cancer Society, “What Do We Know About E-Cigarettes?” June 19, 2019,

For more information, please refer to:

Tobacco Harm Reduction 101: A Guidebook for Policymakers
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101 details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.

PTS-North Carolina: Text
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