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Palgrave Macmillan, Basingstoke McAllister A (2012) Picturing the demon drink: how children were shown temperance principles in the band of hope

Although we cannot make causal inferences from these correlational data, the 2017 ATS provides some evidence in support of ENDS use as a potential gateway to smoking: 54% of current, former, and experimental smokers (see Table 2 for a summary of the four smoking status categories) who thought ENDS were available when they started smoking used ENDS before smoking a cigarette.

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This makes cotinine testing a more accurate way to measure nicotine exposure, whether from direct use or secondhand smoke