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Figure 6 Number of studies analyzed that confirm the relationship between the use of EC and the consumption of conventional cigarettes and other substances DISCUSSION The present study posed the following research question: What are the risk and protective factors for e-cigarette use among adolescents, its association with tobacco and other substance use, and the evidence of its use as a smoking cessation strategy?

Unlike cigarette smoke, inhaling vapour contains thousands less chemicals

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As such, nicotine abstinence may contribute to enhanced pain sensitivity that could maintain cigarette smoking via negative reinforcement mechanisms similar to other withdrawal symptoms [95]