The state of Hawaii is set to receive $6.8 million from a multistate settlement with electronic cigarette maker Juul Labs over its role in the nation’s teen vaping epidemic.

Hawaii Attorney General Holly T. Shikada on Tuesday announced the tentative $438.5 million agreement between Juul Labs and more than 30 U.S. states following a two-year investigation into the company’s marketing and sales practices.

It is an agreement “in principle,” meaning states will finalize agreements over the next few weeks. Hawaii’s share could increase to more than $7 million if Juul chooses to extend payments over more than five years.

“Hawaii’s youth have been disproportionately affected by the nationwide vaping epidemic,” said Shikada in a news release. “This settlement holds Juul accountable for its targeted and misleading marketing and aims to prevent Juul from getting more of our children addicted to its products.”

As part of the settlement, Juul also agreed to fund education programs and refrain from youth marketing, the use of paid influencers and the sales of brand name merchandise or flavors not approved by the Food and Drug Administration, among numerous other requirements.

Many of Hawaii’s anti-­tobacco advocates welcomed news of the settlement but said it was inadequate in proportion to the damage done to a generation of youth.

Hawaii has among the highest rates of youth vaping nationally, with nearly 1 in 3 high school students and about 1 in 5 middle school students reporting themselves as current users of e-cigarettes.

The Centers for Disease Control and Prevention’s latest Youth Risk Behavior Survey in 2019 found the rate of daily vaping that year had more than doubled over two years.

Among middle school students, 18% currently vape, which ranks the state first nationally among 14 states collecting data on the demographic, according to a recent news release from the University of Hawaii Cancer Center.

The highest percentage of e-cigarette users among these youth, the center said, are of Native Hawaiian or Pacific Islander ancestry.

The rate increases to more than 45% for female Native Hawaiian and Pacific Islander youth, according to Scott Stensrud, statewide youth coordinator for the Hawaii Public Health Institute.

With that in mind, the Juul settlement of $6.8 million to Hawaii, payable over several years, is “woefully inadequate,” he said, particularly when Juul’s revenue in 2019 was over $3 billion.

“That’s less than half what CDC recommends Hawaii should be spending on prevention and cessation in a single year,” Stensrud said. ”This settlement seems more like a slap on the wrist versus a message to the industry to keep away from our keiki after they have addicted a new generation to a potentially lifelong addiction to nicotine.”

Stensrud is waiting for more recent figures from the CDC survey, which is conducted biannually, but says he’s hearing from the youth he works with statewide that the situation is only getting worse.

“We’re hearing more and more middle school principals wanting us to come in to do presentations,” he said. “The demand is even at elementary school, so it keeps getting younger and younger, which is very alarming.”

Also, even though Juul pods are off the market, Stensrud said they have quickly been replaced by other brands and products, and that companies such as Puff Bar have quickly stepped in with disposable e-cigarettes. Kids move easily from one device to another.

So the Coalition for a Tobacco-Free Hawaii, a program of HPHI, continues to advocate for a ban on all flavored tobacco products, including flavored vaping products.

During the past state legislative session, a bill that would have done so made it through both chambers, but a last-minute loophole inserted by the Senate that allowed for an FDA exemption defeated the bill’s purpose, health advocates said.

The bill, introduced by Rep. Scot Matayoshi, was eventually vetoed by the governor, who also cited the faulty loophole.

“This is a victory for the anti-vaping movement, but the amount Hawaii will receive from the settlement is far less than the negative impact underage vaping has caused, both in health and educational long-term costs,” said Matayoshi, who has worked to introduce a bill banning flavored tobacco products for several years. “Flavored vaping products need to be banned entirely. Expecting bubble gum-flavored nicotine to not fall into children’s hands is turning a blind eye to a massive epidemic.”

The lawsuit stems back to 2020, when former state Attorney General Clare Connors filed suit against Juul Labs and Altria Group Inc., the parent company of Philip Morris and Juul’s largest shareholder.

The suit sought penalties, damages and injunctive relief for violations of Hawaii’s Unfair and Deceptive Acts and Practices Law.

For more than five years, the suit alleged, defendants misleadingly marketed Juul e-cigarettes, with the intention to hook users the same way tobacco companies did while marketing cigarettes. In particular, Juul was allegedly targeting teenagers with its marketing strategies while falsely understating the nicotine content of its products.

A multistate investigation led by Connecticut, Texas and Oregon affirmed this, revealing that — until recently — Juul rose to become a dominant player in the vaping market by willfully engaging in an advertising campaign that appealed to youth even though its e-cigarettes are illegal for them to purchase.

Juul “relentlessly marketed” to underage users with launch parties; ads featuring young, trendy-looking models; social media posts; and free samples. Juul’s sleek design could be easily concealed, with products in candylike flavors known to be attractive to underage users.

Additionally, Juul relied on age verification techniques it knew were ineffective.

The investigation further found, among other violations, that Juul’s original packaging was misleading in that it did not clearly disclose that it contained nicotine.

Shikada said the settlement, once fully executed, will resolve the 2020 suit but that Altria Group Inc., which is also named in the suit, is not affected.

Juul, meanwhile, is waiting for an FDA decision on whether it will be permitted to continue selling its products. The FDA in June ordered Juul to pull its e-cigarettes from the U.S. market, but the company was given a temporary reprieve after filing a lawsuit.

The Campaign for Tobacco-Free Kids, a nonprofit in Washington, D.C., said the settlement “underscores Juul’s culpability in driving the youth e-cigarette epidemic and demonstrates why the FDA must move forward without further delay in ordering all Juul products off the market.”

“While this settlement is a positive step forward, our kids will remain at risk as long as Juul products remain on the market and other companies continue to market flavored e-cigarettes, including menthol-­flavored products,” said the group in a statement. “To truly end the youth e-cigarette epidemic, the FDA must take immediate action to remove these products from the market.”

The state was represented in the lawsuit by Starn O’Toole Marcus & Fisher of Honolulu and the national law firm Lieff Cabraser Heimann & Bernstein LLP.

Alabama, Arkansas, Connecticut, Delaware, Georgia, Idaho, Indiana, Kansas, Kentucky, Maryland, Maine, Mississippi, Montana, North Dakota, Nebraska, New Hampshire, New Jersey, Nevada, Ohio, Oklahoma, Oregon, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin and Wyoming also signed the agreement.

YOUTH VAPING RATES

Hawaii youth vaping rates are among the highest in the nation:

>> Nearly 1 in 3 (31%) high school students in Hawaii said they currently vape.

>> About 1 in 5 (18%) middle school students in Hawaii said they currently vape.

>> 48.3% of high school students and 30.6% of middle school students in Hawaii have tried a vaping product, including e-cigarettes, vapes, vape pens and e-hookahs.

>> 10.4% of high school students in Hawaii used e-vapor products frequently, 8% daily.

Source: 2019 Youth Behavior Risk Survey, CDC

U.S. YOUTH ARE USING FLAVORED E-CIGS:

>> In 2021 about 2.55 million combined middle and high school students reported current use of a tobacco product (past 30 days) — 2.06 million high school students and 470,000 middle school students. When asked what kind, an estimated 2.06 million (7.6%) said they used e-cigarettes.

>> More than 8 in 10 of these youth use flavored e-­cigarettes.

>> Among youth currently using e-cigarettes, 43.6% of high school students and 17.2% of middle school students reported using them on 20 or more of the past 30 days.

>> Most commonly used e-cigarette devices were disposables (53.7%), followed by pre-filled or refillable pods (82.7%) and tanks or mod systems (9.0%).

>> Puff Bar was the most commonly reported brand (26.8%), followed by Vuse (10.5%), Smok (8.6%), Juul (6.8%) and Suorin (2.1%).

Source: CDC 2021 National Youth Tobacco Survey (online)