At Duke Unversity, 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.”

Complicated Relationship
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% percent 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.

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