It did not take long for word that people were falling ill from vaping to spread among teenagers. The news appeared on Snapchat, where worried adolescents read the grim details of the mysterious illness and shared them with their peers in group text messages. Then there were the photos of young patients that proliferated on Instagram and Twitter showing them listless in hospital beds, tubes snaking from their mouths.
"The news says it's bad for your health," a high school senior in Cary, North Carolina, recalls telling his friends in a group chat. He urged them to stop.
But these were the same forums where some teens were starting to parody their classmates for quitting vaping, and where high school vape dealers - who peddled products containing nicotine and others containing marijuana - were advertising their wares.
The posts offer a glimpse into the contradictory forces teens face: the draw of nicotine and marijuana, the pressure to fit in and be cool, the inclination to rebel - and now the potential that vaping, which has become central to adolescent culture in some places, could cause immediate and lethal harm. Quietly, some teens admit to friends that they are unable to stop, and that the unrelenting stress of adolescent life has driven them to keep vaping.
Interviews with pediatricians, public health officials and more than a dozen teenagers reveal that while many young people are trying to quit, others are resistant to the notion that vaping might be dangerous.
"I know there are people who still vape, definitely," said Chloe Fatsis, a senior at Wilson High in Washington, D.C., and editor of the student newspaper, which plans a two-page spread on vaping this month. "They also just don't care, or they think it won't happen to them."
The U.S. Centers for Disease Control and Prevention reported that more than 1,000 people had been sickened by lung illnesses related to vaping, with teenagers under the age of 18 accounting for more than 150 cases. The youngest patient is 13. At least 26 people have died, according to federal and state authorities, the youngest being a 17-year-old boy from New York.
The bouts of illness have proved terrifying for teens and their families, some of whom have watched their children transform in a matter of days from healthy adolescents into intensive-care unit patients tethered to ventilators.
The crush of news has inspired a new genre of videos on TikTok, a social media platform where users can edit and post short videos and set them to music. Teens record themselves getting rid of their cartridges, e-cigarettes and dab pens - devices the size of pens that often carry THC-laced vaping juice. They set the videos to a melancholic acoustic song, "New Year's Eve," by Mal Blum.
Investigators have not pinpointed a cause for the injuries, but most patients had vaped products containing THC - the main psychoactive ingredient in marijuana - purchased off the street. Industry experts says some distributors have purchased empty cartridges and filled them with their own brew of THC and other chemicals, meaning buyers have no clue what they are putting in their lungs.
Because the cause of the illnesses has yet to be determined, some states have advised all users - including those only vaping nicotine - to stop. Massachusetts issued a four-month ban on sales of vaping products, sparking a backlash from those who have used e-cigarettes to quit smoking tobacco. One in 9 high school seniors nationwide reported vaping nicotine on a near-daily basis, according to the results of a government-funded survey conducted this year. It showed a steep increase in young people vaping nicotine.
Pediatricians have emphasized that even those who do not suffer a serious lung injury are at risk for addiction, and that the effects of long-term use of e-cigarettes are unknown. Even before the outbreak, pediatricians reported alarming symptoms in teens who used e-cigarettes: explosive anger, extreme mood swings, insomnia and headaches. Some teens were vaping nicotine products until they threw up, and were going to extremes to keep vaping even after they faced severe consequences.
But teens, like many adults, have cherry-picked information to justify continued use.
One 17-year-old in Arlington, Virginia, said he has started to steer clear of dab pens. But he said his classmates believe they are safe if they avoid buying black-market vaping products. The dealer who sells to his friends assures them the cartridges come from authorized vendors.
"We try to buy the legitimate ones," he said, speaking on the condition of anonymity so he could speak candidly.
His comments are emblematic of a broader information battle being waged between pediatricians and educators and teens who possess an outsized sense of invincibility. Many teens were turned on to vaping nicotine by Juul, a sleek e-cigarette the size of a USB drive with cartridge flavors such as mango and creme brulee.
Some teens said they did not know that the vapor contained nicotine and that they were at risk of becoming addicted, a misconception that researchers studying adolescent vape use have also found. And because the devices were advertised as a healthier alternative to cigarettes, many teens believe they are safe, even those who are repulsed by traditional tobacco products.
"It tasted good, and it gave me a head rush," said Adam Hergenreder, an 18-year-old recent high school graduate from the Chicago suburbs who was one of the hundreds of teens hospitalized this summer with a vaping-related lung injury.
He said that after he started vaping nicotine, he sought a more intense high and began vaping THC. He said he believed that was safer than smoking marijuana in a pipe.
"I thought that vaping was safe, so to think that that little product did that much damage to my lungs, it was crazy to think about," Hergenreder said.
Hergenreder has joined teens across the country suing Juul, alleging the e-cigarette manufacturer targeted young users.
Juul Labs did not immediately respond Friday to a request for comment, but in the past, Juul has defended the design of its products, saying they were engineered with adult smokers in mind. In response to criticism and scrutiny from the Food and Drug Administration, Juul Labs has taken steps to counter teen use.
The news stories about vaping-related illness have emboldened some teens to be more forceful with their friends about quitting, even though it carries the risk of getting them tagged as square or a nag. Hergenreder wrote a message in a group chat with friends listing the latest toll of the vaping-related illnesses: hundreds, including himself, hospitalized. He urged them to quit, and then wrote, "Please make sure you guys read what I just said." He got no response. Dejected, he left the group chat.
The teen in Cary, North Carolina, who spoke on the condition of anonymity so he could candidly discuss his friends's vaping habits, said he could no longer stay silent, and once again laid out his arguments for quitting in a series of text messages.
"When you have friends, you want them to be around for a long time, and you don't want them to get hooked," he said. He has long been frustrated by his friends' vaping habits but has been careful not to be too forceful, lest he alienate them. But the news stories about people being hospitalized and dying fostered a sense of urgency. He posted in a group text message with nearly three dozen friends, urging them to quit.
Some of his friends have laughed at the warnings, he said. But he said he believes the jokes are a way to mask deepening anxiety: "I truly think they're scared and they want to quit."
At least one friend, who had heard about the health problems related to vaping in his high school journalism class, said he listened. Standing with friends one day last month on the edge of his neighborhood, the 17-year-old announced he was going to quit. His peers scoffed, saying they were skeptical he would follow through.
"Yeah, I am," he said. "I'll prove it."
And with that, he lobbed his vape into the nearby forest.
