It all started at the mall when a friend offered her a puff from a JUUL e-cigarette.

"It was kind of peer pressure," says Beth, a Denver-area 15-year-old who started vaping in middle school. "Then I started inhaling it," she says. "I suddenly was, like, wow, I really think that I need this — even though I don't."

Soon, Beth — who asked that her last name not be used because she hasn't told her parents about her vaping — had a JUUL of her own. She was vaping half a pod of e-liquid a day, the nicotine equivalent of half a pack of conventional cigarettes. She used other brands, too — a Suorin, a Novo and a modified device, which gives users custom vaping options.

Beth tried to quit on her own, so her mom wouldn't find out. But it was hard and her school didn't have enough resources to help her, she says.

"When you wake up in the morning, you're just like, 'Oh, I need to hit my thing. Where is it?' You can't really get it off your mind unless you distract yourself," Beth says.

In a 2018 report from the Centers for Disease Control and Prevention, Colorado had the highest rate of teen vaping of 37 states surveyed. A quarter of those students said they currently used an electronic vapor product — double the national average. Beth guesses half her classmates vape regularly. Her school does offer some tobacco education, but she says teens could use a lot more support to help them to quit.

Beth managed to stop vaping a few weeks back, motivated by the news stories of young people falling ill. Plus, she says, her own friend got sick, and that was a turning point.

Before, she says, "I didn't really take it super seriously, because I was like, oh, what are the chances that that's going to happen to me? And then my friend actually almost had his lung collapse, and he was coughing blood and mucus. And I just couldn't do it anymore. It's not worth it."

As of Oct. 17, the CDC reported it was investigating 1,479 lung injury cases nationally associated with using e-cigarettes, including 33 deaths. Colorado, so far, has recorded nine cases and seven hospitalizations.

A federal survey shows more than a quarter of U.S. high school students have used an e-cigarette in the past 30 days. But public health advocates say that funding for anti-tobacco efforts is inadequate. Although states receive annual payments from tobacco companies as part of a 1998 lawsuit settlement, they're not following CDC guidance on setting aside large chunks of that money to help smokers quit or to prevent new smokers from starting. States can spend that money on whatever they want, and most do.

Another traditional funding source for antismoking programs has been cigarette taxes. But with fewer people smoking cigarettes, that revenue source has been less reliable. In Colorado, cigarette sales have declined by 41 percent since 1990, according to Colorado's health department. And in more than half of the states, including Colorado, vapes aren't taxed — at least not yet.

"It is daunting," says Alison Reidmohr, tobacco communications specialist for Colorado's Department of Health and Public Environment. "We've got more problems than we've seen before and fewer resources with which to deal with them."

An estimated 27,000 Colorado high schoolers report vaping more than 10 days a month, Reidmohr says. "More people are using more nicotine products. Our young people are facing an epidemic of vaping. We're not funded to deal with vaping products."

Colorado spends nearly $24 million a year on tobacco prevention, but according to a recent report from the Campaign for Tobacco Free Kids, that's less than half of what the CDC recommends, and a fifth of what the tobacco industry spends on marketing in the state.

"Really, we have almost nothing in terms of treatment for these kids," says Dr. Christian Thurstone, who runs substance abuse programs for teens in Denver. He says teens have gotten addicted to nicotine so fast, it's uncharted territory.

Though there are websites, hotlines, therapists and coaches to help kids manage nicotine cravings, those efforts were all designed around traditional cigarettes, Thurstone says. He's turned up no studies about adolescents quitting e-cigarettes.

"We need some research, fast," says Thurstone.

A spokesman for the popular JUUL brand says no young person or non-nicotine user should ever try JUUL. But he doesn't say how minors who've started to use the product might quit.

Most teens just need to decide they're not going to use any more, says Gregory Conley of the American Vaping Association. "It's only a small sliver that may actually need some assistance to get off the products," Conley says.

Colorado's health department disputes that; it estimates 10% of the state's highschoolers are vaping nicotine more than 10 days a month.

In July, National Jewish Health in Denver launched a cessation program tailored to teens' needs. In a large open office, coaches answer calls. "Thank you for calling 'My Life My Quit' one says. "Congratulations on making the decision to quit." The program — which uses a traditional helpline, chats and live coaching — has seen a sharp surge in sign-ups in the last month.

My Life My Quit serves Colorado, and is available in 11 other states, as well — Iowa, Massachusetts, Michigan, Montana, Nevada, North Dakota, New Hampshire, Ohio, Pennsylvania, Utah and Wyoming. Clinic director Thomas Ylijoa says data show 12% of high school seniors in the U.S. are using e-cigarettes every day.

Teens are "telling us they can feel their lungs burning when they're using these products," Ylijoa says. "They're telling us that they can't exercise the same way they used to before. They're telling us that they can't give up these products just on their own, that they need help."

The program even added coaching by text, he says, because that's how many teens like to communicate.

In his office, Ylioja reads from a printout of text conversations between teens and coaches. " 'I'm 16 years old. I'm super addicted to vaping. I can't seem to quit when I don't have it, that's all I think about,' " one student writes.

" 'My family is worried and all the stories about people getting sick,' " says another text. " 'I don't know if it's really bad to vape, but because of these stories, they could be rare occasions, but I'm worried about it.' "

"Here's another one," Ylioja says, then reads out loud: " 'So my friends are the ones who got me into vaping and they think I should not stop. But I want to, because I don't want to hurt my family if I get sick.' "

Nichole Lopez, one of the program's coaches, says most teens say they've heard about the vaping sicknesses.

"It's freaking them out," she says. "They're scared. They don't want to die. I had somebody say, 'I just don't want to die, so I need to quit.' "

Lopez says teens often think they're invincible, but news of young people getting sick is suddenly making the dangers seem real.

The Truth Initiative, a nonprofit public health group aimed at helping young smokers quit tobacco use, has also expanded its resources to include a program focused on e-cigarettes. It's a free text messaging program "tailored by age group" to give teens and young adults appropriate recommendations about quitting. It also provides resources for parents looking to help children who are vaping and may want to quit.

Don Daniels, the director of the tobacco education program at Chatfield High in Littleton, Colo., says he senses what he thinks could be a sea change in teen attitudes.

The reports of people being "truly sick and dying from these devices is enough for young people to make a decision that's going to benefit their health," Daniels says. "They're savvy. This is a smart generation and they're thoughtful and they have the ability to make good choices."

Chatfield senior Mia Norrid, a swimmer, doesn't vape. But her mom posted a story about the vaping-linked illnesses on Facebook and tagged her daughter as a nudge to speak up.

"I think she tagged me so I could let my friends know about it, because a lot of my friends do it," she says.

Over lunch, a group of Chatfield ninth-graders showed off what they've seen on social media. In an app called TikTok, a search for "quitting JUUL" or "#stopjuuling" brought up videos of people "breaking their devices and, like, throwing them away and trying to get other people to quit, too," says one freshman.

In one of the videos, someone lit an e-cigarette device on fire; in another, a pair of devices are flushed down a toilet. A third shows someone whacking a JUUL with an ax on concrete.

Social media is often blamed for helping popularize e-cigarettes among teens. Now it may be playing a role in quitting, another Chatfield freshman points out. But do the students think it will make a difference?

"I do, yeah. For a lot of people, actually," the freshman says. "I've known kids who have stopped vaping because of it."

The state intends to survey Colorado high school students in the fall about how much they vape. Results are expected to be released in 2020.

This story comes to us through NPR's partnership with Colorado Public Radio and Kaiser Health News.

Copyright 2019 CPR News. To see more, visit CPR News.

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