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The answer is complex but generally revolves around the additives in tobacco used for traditional cigarettes

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However, e-cigarette vapor still contains nicotine a highly addictive drug carcinogens, ultrafine particles, heavy metals, and other potentially harmful chemicals such as formaldehyde

These results were not surprising considering the participants young age, relatively short e-cigarette use (~ 4 years), and the extensive time it can take for impairments to develop