By Rebecca Heilweil

Updated 1:16 p.m. ET

This week, North Carolina became the first state to take [legal action] (https://www.ncdoj.gov/News-and-Alerts/News-Releases-and-Advisories/Attorney-General-Josh-Stein-Takes-E-Cigarette-Make.aspx) against the e-cigarette company Juul. The state is accusing the company of designing, marketing, and selling e-cigarettes in a way that attracts minors and of downplaying the “potency and danger” of nicotine in its products.

“We had achieved an incredible public health victory in the United States where we had reduced teen smoking from about 27 to 28 percent to about 5 percent over about a 20-year period of time,” North Carolina Attorney General Josh Stein told Cheddar on Friday. “And in just the last three years, all of those gains have been erased. About 30 percent of high schoolers are now using tobacco products. It’s a devastating development and it’s almost exclusively attributed to Juul.”

Stein’s lawsuit also comes amid increasing frustration from investors in Altria, the tobacco giant that bought a 35 percent stake in Juul for [nearly $13 billion] (https://www.cnbc.com/2019/05/16/altria-ceo-howard-willard-grilled-on-juul-e-cigarette-investment.html) last year. At Thursday’s annual shareholder meeting, investors expressed concern over the price the company paid for the e-cigarette startup, especially given the barrage of regulatory challenges Juul faces.

Juul has come under particular scrutiny because of its popularity among adolescents. In [a 2018 letter] (https://www.tobaccofreekids.org/assets/content/press_office/2018/2018_04_18_fda_juul.pdf) to the Food and Drug Administration, several health advocacy organizations including the American Heart Association, the American Lung Association, and the Campaign for Tobacco Free Kids wrote that Juul is popular among minors because it’s small and easy to hide (the product resembles a USB flash drive), it’s available in sweet, candy-like flavors and “appears to deliver nicotine more quickly, more effectively and at higher doses than other e-cigarettes.”

Juul said in a statement that it had not yet seen North Carolina’s complaint, and added that it shared Stein’s concerns about youth vaping. Juul also highlighted its efforts to curb adolescent use of its product, such as conducting “secret shopper” programs to investigate retailers that might be selling to underage buyers, reducing the company’s social media presence, supporting legislation to raise the minimum age for purchasing tobacco products to 21, and limiting the availability of flavors that are popular among minors in traditional retail.

Juul was not willing to provide additional comment on Stein's claim that Juul is primarily responsible for the rise in adolescent tobacco use.

If North Carolina's attorney general is successful, Juul could face some of the toughest government regulations yet. The lawsuit aims to limit the availability of Juul both online and in stores to only tobacco and menthol flavors (Currently, customers can buy tobacco, menthol, and mint flavors in stores, and any flavor onlineーJuul offers flavors like cucumber, mango, and creme ー after verifying their age).

The state is also seeking limits on marketing, such as blocking Juul from promoting itself in locations near playgrounds and schools and in media outlets directed toward readers under 30. “What I want is for a court order for them to cease all marketing toward young people ー all sales toward young people ー and to make sure they pay for the damage that they’ve caused,” said Stein.

“Juul is definitely under pressure right now,” Nathaniel Weixel, a health reporter at The Hill, told Cheddar on Thursday. “I expect North Carolina probably to be the first of at least a few, in the coming months, if not years.”

“A number of states are very interested in what we discovered and want to learn more,” added Stein.

Last year the Massachusetts' attorney general announced that Juul and some retailers that sell its products would be [investigated] (https://www.mass.gov/news/ag-healey-announces-investigation-into-juul-other-online-e-cigarette-retailers-over-marketing), (though that didn’t stop the state’s previous attorney general from joining the [company’s government affairs team] (https://www.masslive.com/politics/2019/04/former-massachusetts-attorney-general-martha-coakley-to-join-e-cigarette-giant-juul.html)). The FDA has also [launched efforts] (https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-new-enforcement-actions-and-youth-tobacco-prevention) to curb the number of retailers selling Juul products to minors. Just Wednesday, a federal judge [ordered the FDA] (https://www.cnbc.com/2019/05/16/federal-judge-orders-fda-to-begin-review-of-e-cigarettes.html) to begin reviewing e-cigarettes, after public health groups sued the agency for failing to regulate vaping products.

E-cigarette use among the youth population is rising sharply. The FDA’s [2018 National Youth Tobacco Survey] (https://www.fda.gov/tobacco-products/youth-and-tobacco/2018-nyts-data-startling-rise-youth-e-cigarette-use) found that there are more than 3.6 million kids currently using e-cigarettes. While vaping among minors declined between 2015 and 2017, the trend sharply reversed last year, with a whopping 78 percent increase among high school students from 2017 to 2018. Yet in a [survey] (https://newsroom.juul.com/2019/05/06/american-journal-of-health-behavior-publishes-study-measuring-prevalence-of-awareness-and-use-of-juul-and-other-vapor-product-among-u-s-adolescents/) commissioned by Juul, and independently designed and administered by the Substance Use Research Centre and Ipsos, 4 percent of youth between 15 and 17 were currently using a Juul product.

“I’ve got two high-schoolers, and they say anytime you go into a restroom in a high school, there is vape aerosol in the air everywhere,” said Stein, adding that his friends’ children, despite medical help, are still addicted to e-cigarettes. In 2017, nearly 17 percent of high school students who use tobacco products in North Carolina reported having [used e-cigarettes in a survey] (https://www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/index.htm).

“It took a long time for traditional tobacco companies to be facing the kind of pressure that Juul is facing now. And I think a lot of it has to do with the lessons that regulators have learned from traditional tobacco companies,” commented Weixel. “They learned the lesson from Big Tobacco. They know that children are getting addicted, and they’ve seen the effects quicker.

For full interview click here.