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However, a growing awareness of e-cigarettes hazards including exposure to high levels of addictive nicotine and toxic chemicals as well as a propensity to act as a gateway for conventional cigarette smoking led the Food and Drug Administration to include e-cigarettes in its 2018 anti-smoking campaign aimed at youth called The Real Cost. A year later, an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) occurred, affecting the health of thousands of e-cigarette users

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User testimonials report improved respiratory effects, though long-term risks still need further research