SACRAMENTO, Calif. (AP) — California public health officials are urging people to stop vaping and using e-cigarettes as a fourth death related to vaping was reported in the state.

The state’s Department of Public Health said Wednesday 161 people have been hospitalized for severe breathing problems and lung damage since August.

The Marin County Sheriff’s Office said Wednesday 45-year-old Amanda Margot Arconti of Vacaville died at a Novato hospital earlier this month. An official cause of death is pending.

The U.S. Centers for Disease Control and Prevention identified Vitamin E acetate as a “potential chemical of concern” but has yet to rule out other causes or ingredients.

More than 2,000 Americans who vape have gotten sick since March, many of them teenagers and young adults. The CDC says at least 40 people have died.