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While the FDA has denied permission to market some e-cigarette products and has recently stepped up enforcement efforts, including warning letters, fines, injunctions to manufacturers and retailers, and joint operations with other federal officials to seize imports of unauthorized e-cigarette products, enforcement has been slow and many of the most popular e-cigarettes among youth remain on the market

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This interaction stimulates the release of several neurotransmitters, including dopamine, norepinephrine, and acetylcholine