State health officials issued an urgent advisory to local residents to stop vaping and said they are investigating a second possible case of serious lung illness associated with vaping in Hawaii.

Nationwide, more than 1,000 cases of lung illnesses and 18 deaths have been associated with e-cigarettes. The Health Department last month confirmed a teenager as the first reported case of vaping-related lung disease in Hawaii.

“That’s probably the tip of the iceberg,” said Health Director Bruce Anderson said today. “Today we just heard about a second serious case that happened to be an adult.”

He said the first individual was hospitalized and has since recovered. But he released no more details about either case.

The Health Department called for a halt to vaping “regardless of substance or source.”

“Vaping is not safe,” Anderson said. “Everyone is advised to stop using vaping products until more is known about their association with serious lung disease.”

Hawaii ranks second in the nation for e-cigarette use among high school students, with an estimated 25.5% currently vaping, twice the national average, according to Health Department statistics. E-cigarettes are even more prevalent on the neighbor islands, with as many as 34% of high school students using the devices.

“There is serious nationwide concern over vaping, and in Hawaii, our children are especially at risk as we have some of the highest estimated rates of e-cigarette use among our high school and middle school youth,” said Gov. David Ige in a statement.

“The state is placing a high priority on investigating lung illnesses related to vaping and our Department of Health will immediately ban any products that are identified as the source of a vaping related outbreak,” Ige said. “We will also introduce legislation to regulate these products and further restrict their access to our youth.”

Many cases of vaping related illness nationally involve off-market products, including the psychoactive ingredient in cannabis, but some victims have fallen ill using only nicotine products obtained on the market, health officials said.

Hawaii’s Health Department is launching a campaign to reverse what it sees as an epidemic of youth vaping. Information is available online at hawaiinovape.com.