Paul Spear was just started as athletic director at Framingham High School when he heard that students were vaping. All he knew was that a friend mentioned he was using the products to ween off cigarettes.

By late 2017, a year later, he was seeing student athletes in his office every week who got caught vaping on school grounds. He had to break the news to them and their parents that they were suspended from a series of games or competitions, due to regulations set by the Massachusetts Interscholastic Athletic Association.

Spear, who became an administrator in 2006, is part of a growing coalition of school officials and pediatricians who say they have been blindsided by the skyrocketing popularity of e-cigarette use among children. One of the biggest differences they say sets current teen smokers from those a generation or two earlier is that the products are increasingly enticing student athletes, threatening their health and hurting their chances at competing at higher levels.

“It’s affected a much wider spectrum of kids. It used to be quite a daring thing to smoke a cigarette in a bathroom because you could smell it, so somebody knew that someone had been smoking,” Spear told MassLive. “With these, there’s no way that you can know.”

The U.S. surgeon general calls it a public health crisis. A 2018 surgeon general advisory noted that one in five high school students and one in 20 middle school students vape. In 2017, the Massachusetts Risk Behavioral Survey reported that about 20 percent of high schoolers use vapes and 41 percent of high schoolers reported ever using e-cigarettes.

Massachusetts lawmakers raised the minimum smoking age to 21 in 2018, in hopes of curbing e-cigarette use. Legislators and public health advocates are pushing for additional restrictions, such as legislation that would ban flavored nicotine products and place an excise tax on e-cigarette products. Supporters of these bills, including those who appeared Tuesday at the State House, say they are hopeful these measures will become law.

“Why would they design a product that takes 8,000 flavors? They do it on purpose because they know that appeals to young people,” said Massachusetts Sen. John Keenan, a Quincy Democrat. He and Rep. Danielle Gregoire, a Marlborough Democrat, are pushing legislation to ban flavored tobacco products.

But school officials, pediatricians and parents say they’re already scrambling to treat a generation that’s quickly becoming hooked on e-cigarettes. More than 150 municipal health boards have passed restrictions on flavored nicotine sales, but students who are already exposed to e-cigarettes say they can easily drive 10 or 20 minutes to a town that doesn’t have a sales ban in place, said Reyad Shah, who works at Framingham High School with Spear.

Some children who vape don’t even realize they’re consuming nicotine, said Jonathan Winickoff, a pediatrician at Massachusetts General Hospital. When he asked his patients if they used e-cigarettes, most said no. Then he started asking them, “do youJUUL?" and their answers changed.

“I wasn’t even asking the right questions, and I think a lot of clinicians still don’t ask the right questions,” Winickoff said. “Once I found out that kids were using, many of them thought that what they were using was not a big deal, that maybe they could stop any time they wanted. Some of them thought that vaping was just water vapor plus some flavor.”

Public health advocates say a “pod” or cartridge carries as much nicotine as a pack of cigarettes. Winickoff says recent analyses of e-cigarette ingredients suggest some products have been mislabeled and carry more nicotine than a pack’s worth of cigarettes.

Winickoff has treated athletes who have been kicked off sports teams for vaping. Many don’t realize the pulmonary and neurological effects of using e-cigarettes, including asthma and lung conditions.

“It’s not just about coming off the product,” he added. “It’s about needing to treat them with steroids to get them back to normal.”

Kristin Beauparlant’s son, Cade, was captain of the hockey team until he got caught using e-cigarettes in school. He started undergoing treatment for nicotine addiction and learned he had developed a lung disease after at least four years of using nicotine products.

“He was a good kid, very smart, very athletic, kind of had everything going for him, and then things just changed,” said Beauparlant, a nurse and a mother of three from Newburyport.

Kristin Beauparlant, a nurse and mother of three, recalled how her son struggled with nicotine addiction.

Beauparlant, who spoke Tuesday morning at the State House, recalled how her son first asked his grandmother for a vape pen for Christmas when he was in eighth grade. She and his dad reprimanded him, but they still came across pods from time to time.

When he was a freshman hockey player, he would sit out because he couldn’t breathe. Soon, he grew anxious and angry.

“He was a child that would scream and yell and swear, call me names. Then he’d just leave,” Beauparlant said. “I’d be like ‘Where is he going?’ And then I realized he was going to do his JUUL.”

In schools, children are seen charging their vaping devices on their laptops. Oftentimes, they look like memory sticks.

At Framingham High School, teachers walked right past students using their laptops to charge the devices, Spear said. Some saw students drop the devices only to have the teachers hand them back to the students, not realizing they were vape pens.

For Spear, the trend was infuriating. The high school’s athletic teams started losing multiple key players, and students weren’t heeding the warnings about possible health risks.

In February 2018, he got fed up and posted an open letter about vaping on Facebook.

Open Letter to All FHS Student Athletes and their Families: Please stop vaping. Don't do it in your car, with a... Posted by Framingham High School Athletics on Friday, February 2, 2018

Student athletes are still getting suspended, Spear said. At a Tuesday State House event, Spear told attendees that there were two student athlete suspensions on Monday alone.

“From the athletic standpoint, it’s heartbreaking,” he said at a Tobacco Free Mass news conference. “The worst part of my job is telling a student athlete they can’t compete because they’ve done something that precludes them from being part of their team.”

Those athletic suspensions mean they missed out on playoff games, cheerleading competitions and other major sporting affects that could determine whether or not they’re recruited for collegiate sports.

Beauparlant, the Newburyport mother, said her son “had people who were interested in him for hockey, and all of that went right out the window.”

Beauparlant said a bell went off in her head when her son was caught smoking with a group of friends in school. He lost his captaincy on the hockey team, but even then, she said, he denied that he was smoking. He was ready to quit the sport altogether in frustration.

“To him it was more acceptable to just walk away than to accept any consequences,” she said.

Even she, a nurse, had trouble finding resources — “unfortunately, the schools are learning,” she said. She reached out to doctors at MGH, where she works, and got Cade treatment for nicotine addiction. That’s when he was retested and diagnosed with a restrictive lung disease.

Some schools have suspended students altogether, while others only enforced athletic suspensions for students on sports teams. At Framingham High School, Principal Carolyn Banach said students have been suspended but that the district is looking into restorative practices that can help students avoid getting hooked on e-cigarettes or at least explore the risk factors.

School officials say they call the parents, refer the students to the nurse’s office and make other recommendations, but sometimes parent’s don’t understand the severity of the incident or teenagers refuse to accept that e-cigarette use leads to nicotine addiction.

Beauparlant said Cade eventually acknowledged he was addicted to nicotine and focused on his treatment and therapy. As time passed, he started acting calmer, focusing more. He graduated high school this year and plans to attend the University of Maine to study business.

“He lost four years of his life," she said. “I lost my son for four years, like he was a completely different child."

“Now you see the changes,” she added. “I remember getting calls from teachers and the principal at school saying, ‘It’s so nice to see him smiling and walking down the hall, like a different kid.’”