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Due to the methodological limitations of interpreting causality from this descriptive population-level trend analysis and the multitude of influences on population-level e-cigarette use (e.g., policy changes, cultural changes, historical cohort effects), the ecological analysis does not provide strong evidence to rule out a possible risk-enhancing effect of e-cigarette use on youth smoking

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a low-stimulation, high-comfort setting makes cravings easier to ride out and gives the nervous system the room it needs to settle into healthier routines