Washington - 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, DC, 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 US 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 US states have advised all users - including those only vaping nicotine - to stop.