Everyone in Hawaii should stop vaping until more is known about how it is triggering serious lung illnesses, officials announced Monday as they began investigating a second possible case here.

Gov. David Ige joined health officials at a news conference to issue an urgent advisory calling for a halt to vaping “regardless of substance or source.” Last week the Health Department reported that a youth in Hawaii was hospitalized with the state’s first case of vaping-related lung disease.

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

He said the first patient has recovered and that no specific vaping product was identified as a culprit, but samples were sent to federal officials who are searching for common threads in the outbreak. No further details were released on either case.

Nationwide, 18 deaths and at least 1,080 cases of serious breathing illnesses have been connected to vaping nationwide, and more cases keep cropping up.

Some states are taking sweeping steps in response. Massachusetts declared a public health emergency Sept. 24 and banned the sale of vaping products for four months. New York and Michigan have banned the sale of flavored electronic cigarettes. Vaping retailers are challenging those moves.

“We are not looking at immediate bans at this point in time,” Ige said. But he and Anderson said they would act quickly to embargo any product that is specifically identified as a source of the vaping-related illnesses.

Officials are especially concerned about youth in Hawaii who have flocked to e-cigarettes at among the highest rates in the country. They have launched a campaign including an online website for students, parents and educators at HawaiiNoVape.com.

“This issue has exploded,” Anderson said. “Vaping has become very, very popular in a small amount of time.”

“Flavors are obviously targeting kids,” he added. “That’s clearly a marketing strategy — get the kids addicted to nicotine. Nicotine is probably one of the most addictive substances we know.”

High school students in Hawaii are twice as likely as their peers nationwide to vape. An estimated 26% of high schoolers here report electronic cigarette use, compared with 13% nationally.

Neighbor island rates are even higher, with more than 30% of high school students in Hawaii, Maui and Kauai counties saying they vape. The vaping rate in Hawaii middle schools — 16% — is the highest in the nation.

“We are concerned with vaping because it appears that our young people think it’s safe,” Ige said. “Our message today is that it’s not safe. We encourage everyone who is vaping to stop vaping.”

Many youth obtain electronic cigarettes online and sell them to friends. The Ige administration will again urge the Legislature to start regulating the sale of electronic smoking devices as tightly as it does cigarettes, including prohibiting online sales.

Anti-smoking campaigns and high taxes had helped cut the tobacco smoking rate in Hawaii to one of the lowest in the nation prior to the onset of electronic smoking devices.

Many victims who have fallen ill after vaping reported using off-market products, including THC, the psychoactive ingredient in cannabis. But some say they were using only nicotine products obtained from regular retailers, according to the Health Department.

Gregory Conley, president of the American Vaping Association, said health officials should focus on the risk posed by “knock-off THC cartridges” rather than going after vaping as a whole.

“With the evidence we have today, it is irresponsible to not issue a clear and upfront warning about using illicit THC products,” said Conley, whose nonprofit says it focuses on “sensible vaping regulation” and does not represent the industry.

“This is a clear public safety issue,” he told the Honolulu Star-Advertiser. “In the states that have many reported cases — Utah, California, New York, Michigan and others — the link with amateur made marijuana oil cartridges becomes clearer every day.”

A Sept. 30 update from the Utah Department of Health on vaping-related lung injury reported that more than 90% of the 34 patients who were interviewed said they had used THC cartridges, 63% had vaped nicotine and many did both. The department described THC cartridges as “the likely driver of this outbreak of severe lung injury.”

VAPING SOARS

Hawaii high schoolers are twice as likely to vape as their peers nationally.

Percentage of high school students who say they vape:

Nation: 13%

Hawaii: 26%

Hawaii County: 34%

Maui County: 32%

Kauai County: 32%

Honolulu County: 22%

No Vape Campaign

Information for students, parents and educators is available online at HawaiiNoVape.com

HEALTH DEPARTMENT RECOMMENDATIONS

>> Do not use e-cigarettes or vaping devices of any kind.

>> Avoid off-market products, especially with THC-containing liquids. “Off market” means available online, bought on the street or homemade.

>> If you have used a vaping device and have coughing, shortness of breath, chest pain, nausea, diarrhea, fever or abdominal pain, see a heath care provider or call the Hawaii Poison Hotline at 800-222-1222.

>> Children, youth and pregnant women should never use e-cigarettes or vaping products of any kind.

>> Do not switch from vaping to smoking cigarettes. Consult your doctor, pharmacist or call the Hawaii Tobacco Quitline at 800-QUIT-NOW (800-784-8669).

Source: State Department of Health