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We cannot determine whether e-cigarette use preceded or followed the development of hypertension, nor can we exclude the possibility that individuals who switched to e-cigarettes were systematically healthier or more health-conscious than those who continued smoking, introducing selection bias

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13, 2024 American Lung Association, What's in an E-Cigarette

Recent use involved a quarter of high school students (24.2%), and 3.8% of high school students used them daily