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This also appears to be affecting new restrictive legislation in other communities around the world as they look to the US example

A ritual with nicotine reinforcement tends to stay

Castro-Rodriguez, J

There are many reasons for this increase, such as changing social and economic factors

A recent systematic review with GRADE assessment found that smoking cessation and, in more limited evidence, switching to exclusive e-cigarette use were associated with early improvements in pulse wave velocity, augmentation index, and flow-mediated dilation, changes that are biologically compatible with improved arterial compliance and reduced vascular tone, and thus may contribute to lower blood pressure, although overall certainty was low (moderate only for RCT evidence on flow-mediated dilation) [25]