The rise in vaping-related illnesses and deaths in 2019 was one of the top healthcare stories of the year and has put many people on high alert when it comes to vaping. According to the Centers for Diseases Control and Prevention's most recent update on Dec. 17, 2,506 people have been hospitalized with lung injuries related to vaping and 54 people have died in 27 states.

The issue relating to vaping came to light this past summer, and although the CDC says the rate of illnesses has been declining since September, vaping remains an ongoing problem even though progress was made in identifying vitamin E acetate as the likely substance behind the illnesses. That's bad news for stocks with exposure to vaping, like Altria (NYSE:MO). And things could get even worse in 2020.

Social media cracking down on vaping

Facebook-owned Instagram announced in December that influencers who promote products will not be able to advertise vaping products. The social media giant issued a statement that said, "Branded content that promotes goods such as vaping, tobacco products and weapons will not be allowed." The restriction also applies to Facebook. In the U.K., the British Advertising Standards Authority took similar steps by updating its guidelines, no longer permitting tobacco companies to advertise e-cigarettes on social media.

Vaping pen

Image Source: Getty Images.

It's a move that should help bring the number of vaping-related illnesses down. Vaping has been popular with young people, who've been the demographic most impacted by the outbreak of illnesses -- the CDC reported that 78% of patients who had vaping-related injuries were under 35 years of age.

E-cigarette maker JUUL Labs, which Altria has invested in, could experience a dent in its sales as a result of the social media crackdown. According to data from the Journal of the American Medical Association, the rate at which teens are using vapes nearly doubled in just one year. In 2018, 7.5% of high school seniors reported vaping pot within the past month. That percentage has since climbed to 14% in 2019. 

Fewer teens vaping would mean sales for e-cigarette maker Juul could crater. Sales have already been falling, and the danger for a company like Altria that has already written down its investment in Juul by $4.5 billion is that there may be an even bigger problem around the corner.

Health officials could pull Juul's products from store shelves

Declining sales may just be the tip of the iceberg for Juul. The U.S. Food and Drug Administration (FDA) has a May deadline for e-cigarette makers to submit applications showing that their products don't cause more harm than good, proving that they contribute a "net benefit to public health." 

That could prove to be an uphill battle. According to a recent study by the American Journal of Preventive Medicine, there are serious health risks associated with vaping over the long term. Analyzing data from 2013 to 2016, health officials found links between vaping and a higher chance that an individual will be diagnosed with chronic obstructive pulmonary disease and other respiratory illnesses. Stanton Glantz, a senior author of the study, said, "The odds of developing lung disease for the e-cigarette users was increased by about a factor of 1.3, and for the smokers it was about 1.6. If you're a dual user, it's 3.3."

With e-cigarettes carrying many risks and not showing much success in reducing the number of cigarette smokers in the U.S., making the case for a "net benefit" is not going to be easy.

What does this mean for investors?

Investors have to be aware of the serious risks facing companies with exposure to vaping. How the FDA rules on the safety of Juul's products will have a significant impact on Altria and other stocks relying on vape sales for growth, including certain marijuana stocks. A ban on the products will undoubtedly send share prices crashing down in a hurry, and Altria may end up writing down its investment in Juul yet again. 

If you want to invest in vape stocks or companies that will benefit from vaping, the safer approach would be to wait until after the FDA makes its rulings and there's a clearer picture of which products, if any, it will permit. 

This article represents the opinion of the writer, who may disagree with the “official” recommendation position of a Motley Fool premium advisory service. We’re motley! Questioning an investing thesis -- even one of our own -- helps us all think critically about investing and make decisions that help us become smarter, happier, and richer.