NEW YORK — At Duke University, at the epicenter of North Carolina’s tobacco country, a tense showdown over college vaping and its health risks is roiling the campus.

The standoff began with an Oct. 7 letter to the student-run newspaper, The Chronicle, from Loretta Que, a pulmonologist at Duke University Medical Center. The letter, co-signed by seven other faculty members, urged the university to ban vaping in the wake of a wave of life-threatening lung injuries among young people. Que and her colleagues have themselves treated half a dozen such cases of serious vaping-related lung disease at the medical center, including two college students.

“We’re very concerned about all the vaping incidents in the news, and we didn’t like that we had not actually taken a stand as a university against vaping,” Que said.

Four days later, Jed Rose, a professor of psychiatry and behavioral sciences who directs the Duke Center for Smoking Cessation, fired off a counter letter to the paper. He and co-signers he identified as “concerned tobacco addiction treatment and policy experts” called a proposed campus-wide vaping ban “unwise.”

Rose argues that switching to puffing on an e-cigarette is a proven way to quit the cigarette habit. In his view, vaping can save lives. “The enemy is death and disease — not people, not companies,” he said. “Whatever works to get people to quit smoking, I am in favor.”

The issue of vaping is so divisive on campus that Rose’s colleague, James Davis, the center’s medical director, recently presented the undergraduate student government with a proposal from some of the university’s administrators to ban e-cigarettes.


“We have five patients in our hospital with this syndrome now,” he told students. “This is probably going to continue happening.”

Duke has been grappling with its complicated relationship with nicotine and tobacco for decades.

Its history is intertwined with tobacco farms and the birth of the cigarette industry. The school is named after an old tobacco farming family that dates back to the 19th century.

The Duke family later introduced cigarette manufacturing to Durham, the future hometown of the university, and eventually formed the American Tobacco Co., a monopoly that controlled 90% of the U.S. cigarette market in the late 1800s. That dynasty held tight control over the industry, so much so that the Supreme Court ruled to break up the company in 1911. The Duke family has contributed massively to the university, including almost $1.4 billion in inflation-adjusted dollars from family scion James B. Duke in the 1920s, according to the university’s endowment.

A statue of James B. Duke, cigar betwixt his fingers, placidly looks down on groups of students, studying or relaxing on the neatly cropped lawn. But if tobacco — and tobacco money — is woven into the fabric of Duke, vaping presents a whole new set of problems.

When Lindsey Rupp, a co-author of this article, graduated in 2012, vaping was virtually unheard of. By the time co-author Riley Griffin graduated in 2018, it was ubiquitous with students taking drags from their devices at every turn — in the library, walking to class, or between quaffs of beer at parties.


In 2018, the Center for Disease Control and Prevention and the Food and Drug Administration reported that more than 3.6 million U.S. youth, including 1 in 5 high school students, had vaped within a month. As an emerging generation of vapers leave home for campus life, universities like Duke are inheriting questions of how to manage and regulate what U.S. health officials have called a growing epidemic.

At last count nearly 2,290 vapers have sustained injuries this year — and 47 people have died as of Nov. 20, according to the CDC. An agency report states that the lungs of injured patients, which look as though they’ve been exposed to chemicals in an industrial accident, are ridden with vitamin E acete, a gummy chemical syrup often added to vaping liquids. At Duke University Medical Center, doctors have already identified about half a dozen such cases among young adults.

“We didn’t want Duke to be responsible for a generation of young nicotine addicts.”

Rose, who has received research funding from companies that make vaping-devices, doesn’t minimize the tragedy of vaping-related injuries and deaths. He just doesn’t believe vaping technology per se is the culprit.

The problem, rather, lies with unregulated players who peddle dangerous substances, especially those containing THC, the psychoactive ingredient in marijuana.

He has received more than two dozen grants from the National Institutes of Health to study cigarette addiction and treatment. That research has helped pave the way for the nicotine patch and other cigarette alternatives. Rose has also served as an adviser to Marlboro maker Altria Group, Inc., as well as Philip Morris International Inc. and e-cigarette maker Juul Labs.


Duke’s Center for Smoking Cessation was initially funded by the tobacco industry, which was required to pay for smoking research by the courts. Rose, who first began prototyping e-cigarettes in the 1980s, sold early vape technology to Philip Morris in 2011. Duke had the option to claim the intellectual property at the time but passed up the chance out of fear that the device would expose non-smoking youngsters to an attractive new form of nicotine delivery, said Ross McKinney, who served at the time as the director of Duke’s Trent Center for Bioethics, Humanities, and History of Medicine.

“We didn’t want Duke to be responsible for a generation of young nicotine addicts,” said McKinney.

Vaping eventually came to campus anyway. Although vaping and smoking have long been banned indoors, many students are still puffing away on traditional and e-cigarettes in the library, in dorms and while walking to class. (By comparison, New York City banned smoking in restaurants in 2003. Michael R. Bloomberg, mayor of New York at the time and founder and majority owner of Bloomberg News parent Bloomberg LP, has campaigned and given money in support of a nationwide ban on flavored e-cigarettes and tobacco.)

In July, Duke will finally ban tobacco smoking campus wide. But vaping may continue. While campus leaders debate adding e-cigarettes to the policy, the university currently intends to offer educational programs to drive home the health dangers of vaping. That doesn’t look so proactive compared with higher education at large. At least 2,074 universities and colleges across the U.S. now prohibit all vaping on campus, according to an October report from the American Nonsmokers’ Rights Foundation.

Still, the tide may be turning of its own accord. Although “Juuling” remains prevalent on the Duke campus, undergraduates say the prevalence of vaping has begun to wane as they see more of their classmates end up in the hospital. “It doesn’t have the cultural presence that it did a year ago,” said Mehul Kumar, 19. But if vaping is somehow seen as less cool, it’s not likely to go away anytime soon.

“So what if the ban were implemented?” said Kumar. “People won’t use it in the library. But they’ll use it in their dorms. You can’t enforce these things.”


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