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Although the overall mortality in even the heaviest cigarette smokers (25 or more a day) was only about twice that in non-smokers, this ratio is more extreme in middle than in old age and the great number of deaths attributed to vascular causes (more than half of the total) means that the absolute excess mortality from vascular diseases in cigarette smokers was more than double that attributed to the cancers of the respiratory and upper digestive tracts that are so much more closely related to smoking

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Second, half of current users are nonsmokers, suggesting that unlike tobacco harm-reduction products, e-cigarettes contribute to primary nicotine addiction and to renormalization of smoking behaviors." All young adults who tried e-cigarettes reported also trying a menthol or fruit-flavored device