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According to a CDC survey of state tobacco laws, 10 states have yet to explicitly ban e-cigarette sales to minors

Any additional ethical approval was adjudged unnecessary for the present study

Because all participants were smokers at baseline, it is possible that most started smoking before using e-cigarettes, leaving the temporal precedence of the association unclear

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Cigarette smoke contains thousands of toxic chemicals that reduce oxygen levels, narrow blood vessels, and increase oxidative stress throughout the body, including the eyes