North Carolina saw a large surge in e-cigarette usage amongst teenagers as the youth vaping epidemic grew in the United States. From 2019 to 2019, e-cigarette usage increased among high-schoolers by 78% and among middle schoolers by 48%, according to a NCDHHS survey. With the development and rise of JUUL, the numbers increased to more than 5 million youth nationally using e-cigarettes in 2019. The numbers reported in North Carolina on high school student usage by NCDHHS was higher than the national average. The 2022 NC Youth Tobacco Survey showed that one in eight high school students in North Carolina were currently using a tobacco product with e-cigarettes being the most used product, prompting the high usage rates to define this is a state epidemic.
The rise in rates lead the North Carolina Department of Justice (NCDOJ) to launch an investigation in Juul Labs in October of 2018 to inquire about their marketing practices to engage youth in utilizing their products, age verification efforts, and youth education and prevention programs. The investigation lead to the first state lawsuit filed by Attorney General Josh Stein against Juul being filed in May 2019. NCDOJ stated the basis of the lawsuit was against Juul Labs for "selling it's e-cigarettes to attract young people and for misrepresenting the potency and danger of nicotine in it's products in violation of North Carolina's Unfair and Deceptive Trade Practices Act." It made strong claims on the public deception by Juul Labs about the health harms of vaping, and that Juul Labs marketed usage of the JUUL product as a way to quit smoking without final FDA approval.
The lawsuit complaint document is linked here, made public by NCDOJ.