CRYSTAL LAKE, Ill. — In Alabama, a school removed the doors from bathroom stalls to stop students from sneaking inside to vape. In Colorado, a school decided to forfeit a volleyball game after finding “widespread vaping” and other infractions by the team. And in Pennsylvania, at a school where administrators have tried installing sensors to detect vaping in bathrooms and locker rooms, students caught with vape devices face a $50 fine and a three-day suspension.
At least 530 people have been sickened by mysterious lung illnesses related to using e-cigarettes with nicotine or vaping THC, the psychoactive ingredient in marijuana, and at least eight have died. That has sent high schools, the epicenters of youth vaping, racing to give teenagers a new, urgent message: Vaping can be deadly.
Federal health officials have yet to pinpoint an exact cause of the recent illnesses, but the alarming pattern has put principals and teachers into crisis mode. They are holding assemblies to warn students about the dangers. They are getting creative with rules to make it harder for students to secretly vape in school bathrooms, hallways and even classrooms. They are trying to train parents and teachers on the wide array of vape devices, which look like pens or flash drives and which many adults do not even recognize.
During an assembly at one suburban Chicago high school this week, hundreds of students, many dressed in school colors of orange and black in honor of homecoming, saw an X-ray image of a young man’s lungs, cloudy and damaged, on an auditorium screen.
He had recently been hospitalized after vaping and placed in a medically induced coma for a week, a substance-abuse consultant told the students from a stage.
“His lungs are now that of a 70-year-old. He’s in his 20s,” the consultant, Ashleigh Nowakowski, said. “Can you imagine how that’s going to affect the rest of his life? He can’t run. He can’t play sports.”
The students watched solemnly. A few squirmed in their seats.
Administrators at American high schools have long tried to warn students about the risks of vaping, which gained popularity several years ago as an alternative to cigarettes and works by heating liquid and turning it into vapor to be inhaled. But the outbreak of illnesses has brought new levels of urgency and attention to the issue. Students who had brushed off the warnings in the past, saying that vaping was relatively harmless, could no longer do so.
After the assembly, at Crystal Lake Central High School, 45 miles northwest of Chicago, some students said they were skeptical that vaping was as dangerous as the presentation suggested.
The students told of a high school ecosystem where vaping devices are easily obtained, and refill cartridges with THC oil, known as carts, are sold for $20 apiece. It is not uncommon, these students said, for seniors to sell vape pens to freshmen, eager to take up vaping.
Opportunities to vape discreetly are everywhere, they said — in an empty hallway, a bathroom stall or the back row of a classroom where a teacher cannot possibly monitor every student’s move. Older students said they tended to leave campus for lunch, vaping in their cars along the way.
“It’s rare to find someone who doesn’t do it,” said Alexis Padilla, 16, a junior. “You can’t go on social media without someone’s videos of them doing it.”
Last week, the Trump administration said it planned to ban most flavored e-cigarettes and nicotine pods, an attempt to curtail use among teenagers. States tend to regulate e-cigarettes like other nicotine products, and laws vary. At least a dozen states have passed laws restricting sales of e-cigarettes to young people; in Illinois, Arkansas and other states, the legal age for purchasing nicotine products, including e-cigarettes, is 21. In Texas, minors can be fined for possessing e-cigarettes.
But many teenagers sidestep the age restrictions by buying e-cigarettes online or from friends.
In one group of the Crystal Lake students — girls carrying patterned backpacks and wearing tattered Chuck Taylors — three said they personally knew people who had become seriously ill after vaping.
One friend who had vaped nicotine for two years using a Juul, the dominant seller in the market, was hospitalized with a respiratory lung defect, but has recovered, one student said. Another girl who vaped regularly suddenly could not breathe one day, the students said, and she now has to use an inhaler every four hours.
Sophia Scarfe, a 17-year-old senior, said her parents routinely sent her news articles about the dangers of vaping. Many students have moved beyond vaping nicotine, she said, routinely using THC oils instead. “Vaping anything else other than nicotine is way more common,” she said.
Alcohol is still widely consumed among teenagers, they said. But “vaping is the big thing,” said Nyanan Bey, 17, a senior.
One student openly laughed when she heard a widely cited statistic from the 2019 National Youth Tobacco Survey that estimated that one in four youths between the ages of 12 and 17 have tried vaping nicotine or THC at least once.
“Yeah, that’s too low,” she said. “Literally everyone vapes.”
Health officials suspect that vaping-related illnesses and deaths are underreported, and that doctors have only recently begun to connect vaping to mysterious lung ailments.
And educators said they were beginning to grapple with the reality that a new generation of American teenagers, one that would be loath to pick up cigarettes, is now addicted to nicotine through vaping.
There is nothing out of the ordinary about the students at Crystal Lake Central, a school of 1,500 students, said Steve Greiner, student services coordinator.
“The kids in our school are like any other school,” he said. “People are really starting to realize, ‘Holy cow, this was seen as the answer to our prayers to get people off cigarettes.’ Now it’s turned into this.”
Administrators there have stationed teachers in the hallways between classes to deter vaping. Some have worried that Crystal Lake is only 30 miles from a town in Wisconsin where the police this month said they uncovered an illegal vape-pen factory that was producing 3,000 cartridges of THC-laced oil a day, with a distribution network that is believed to have been extensive.
At a separate informational session for teachers in the auditorium after school on Wednesday, another substance-abuse consultant guided teachers through the world of teenage vaping. The numbers “710” — which spell “oil” upside down — are a code for vaping, the consultant explained. Vaping devices might be found in unlikely, out-of-view places — inside the cord of a hoodie or dangling from a key chain. “Girls sew them into their jeans, next to the zipper,” Dave Shutters, the dean of students, added.
In Crystal Lake, the typical response to a student caught vaping is counseling and other efforts to provide information about the dangers. Some schools have tried vaping support groups.
At Nerinx Hall, an all-girls Catholic school in the St. Louis area, students are planning a peer-driven “amnesty week,” where they hope to make an “emotional appeal” to one another and offer a chance to dump vaping equipment at a secure drop-off location, said Meta Stephens, the senior class treasurer.
“We really want it to be no pressure: You will not get in trouble for this,” said Ms. Stephens, 17, who is helping plan the event this fall. “We really just want to help you stop if you want to.”
Sarah Mervosh contributed reporting from New York.