In this Oct. 4, 2019, file photo, a woman using an electronic cigarette exhales in Mayfield Heights, Ohio. Credit: Tony Dejak | AP

The surge in vaping among teens has alarmed many parents, pediatricians and teachers. Though the chemical of primary concern linked to reported illnesses and deaths has been identified as vitamin E acetate, the U.S. Centers for Disease Control and Prevention has said that none of these devices are safe because they contain nicotine and other harmful chemicals. And even if a young person does decide to quit, it can be hard to do.

Noah, who didn’t want to share his last name, said he first dabbled with vaping while in middle school. He said he started out with non-nicotine vapes. Then, in high school, he tried one with nicotine.

“And it was like, ‘Yeah. I need one of these.’ Because the rush, it just felt so good,” he said.

But now, at age 18, Noah said e-cigarettes sometimes make him feel sick.

“Like my lungs hurt,” he said. “My stomach is upset. And it’s weird. It’s a weird feeling. I’ll go to hit the Juul or whatever and I can’t even inhale because it’s just like my body’s rejecting it because I feel so sick from it.”

Vaping doesn’t feel good, Noah said, but stopping doesn’t, either. When he tries to quit, he’s irritable and can’t sleep. Even nicotine patches don’t help. He’s not sure what to try next.

“I’ve tried so many times, and I’ve failed every single time, so I wouldn’t know what to tell anybody,” he said

How to quit is a puzzle with which pediatricians, substance use counselors and others who work with teens are also wrestling.

In Brunswick in mid-October, local teachers, counselors, school officials and staff from Mid Coast Hospital met to figure out how to help students understand the risks of e-cigarettes and connect students to help. The hospital’s director of substance abuse prevention, Melissa Fochesato, opened the session.

“The expectation is not that any one of us is going to solve this,” Fochesato said. “We’re all going to be rowing in the same direction. This is a community issue.”

Mid Coast Hospital recently established a new text line for teens to make an appointment with a counselor. The hospital is also setting up a cessation support groups for teens. But some pediatricians have said they aren’t sure how to advise young patients.

“You feel like you’re walking in the fog trying to help youth,”said Dr. Deborah Hagler, a pediatrician at Mid Coast. Hagler said this public health issue has emerged so quickly that it’s unclear what the most effective strategies are. While e-cigarettes share the same addictive substance as regular cigarettes, Hagler said other factors can drive dependence in young users, such as behavioral cues.

“In an adult, you might have your cigarette at a bar at the same time in the same place. With kids using their nicotine in an e-cigarette, you don’t know the behavioral patterns,” said Hagler, who is the president of the Maine chapter of the American Academy of Pediatrics, which is Collaborating with public health officials and others across the state to identify effective treatment options. “Are they the same? Are they going to be amenable to other interventions, as say, traditional combustible cigarettes, and sort of the environmental cues? We think so, but we just don’t know.”

Dr. Nirav Shah, the director of the Maine Center for Disease Control and Prevention, said strategies for quitting e-cigarettes are complicated by the fact that some contain as much nicotine as an entire pack of regular cigarettes.

“The questions that are out there is that because individuals using e-cigarettes are taking in so much nicotine,” Shah said. “For example, how many lozenges should someone need in order to start moving away from e-cigarette use? We generally know what that answer is for regular cigarettes, but what is it for e-cigarettes? The same thing with patches. The same thing with gum. That’s an area that a lot of researchers are focusing on right now.”

Shah said the state has seen an uptick this fall in calls about vaping to its Tobacco HelpLine, but they are mostly coming from concerned parents and schools — not from teens themselves.

Vicky Weigman, the substance use prevention counselor for the Lewiston School Department, said many students remain skeptical about the risks of e-cigarettes. Her education strategy has been to spread information wherever she can — in classes, in bathroom stalls, on school TVs — and to encourage students to use text based apps that offer daily tips for quitting.

“I’ve found over time this age group doesn’t love the traditional support group, and sit and get education, and let’s all have a group goal,” Weigman said. “They’re much more covert in their actions, so I do think that’s probably the best approach.”

The ultimate goal for public health officials is to prevent kids from ever starting to vape.

Jake Warn, 20, said that’s the wisest course of action, based on his experience. Warn said he started vaping in high school for social reasons. In college, it became a stress reliever.

He didn’t think it was affecting his health until he came home for Thanksgiving break his freshman year, and his dad asked him to play soccer.

“I felt like crap. I mean, I barely could breathe, and it was only two weeks coming off of a collegiate high-level D2 soccer experience, so I was pretty taken aback by that and didn’t know what was going on,” Warn said.

Warn said he tried to quit cold turkey. Then he tried to taper. He also used texting apps for quitting, but they didn’t help curb his cravings. He tried nicotine lozenges and gum. He said he had the most success with the prescription medication Chantix.

But the urge is still there.

“I definitely still crave it,” he said. “Even now, months after, I can’t lie and say I don’t get a rip here or there.”

Warn considered himself lucky, though. He worried that as kids are starting to vape at an earlier age, they will have a much taller mountain to climb.

“It’ll be hard for certain kids to really shake this. It could be a long, life thing for them,” he said.

This article appears through a media partnership with Maine Public.