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Additionally, participants who reported having used e-cigarettes in their lifetime and currently do not use e-cigarettes (defined as former e-cigarette users) were excluded from the study population because of lack of clarity of exposure status and residual effects that have resulted from the e-cigarette derived chemical exposure which contribute to changes in the continuum of the disease progression leading to molecular changes detectable by biomarker analysis rather than reports

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[15] Concerningly, of youth currently using e-cigarettes in 2025, 27.5% reported daily use, and 41.2% reported frequent use (2030 days per month)