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But it is rarely as simple as another part of the blend opened up, which is how commercial reviewers often explain it

The American Cancer Society recently highlighted the role of our flagship smoke-free product in the rapid decline in cigarette sales in Japan, which has seen its rate of decline in cigarette sales quintuple from a 2 percent decline per year from 2011 through 2015 to a 10 percent decline per year from 2015 through 2018, all without a major change in national tobacco control policy

One study found e-cigarette use was associated with lower forced expiratory volume in 1 second ([FEV1] 4.6 versus 5.2, P = 0.007) and lower ratio of FEV1 to forced vital capacity ([FEV1/FVC] 77.4 versus 83.4, P = 0.001).[44] Since smokers of combustible cigarettes were excluded from this study, these results suggest that e-cigarette use may be independently associated with obstructive airway changes

Edin Evins of Harvard Medical School also contributed to this research