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Some merchants circumvented the price limit by hyping scarcity and engaging in private transactions, leading to the reappearance of "Luxury Cigarettes" in the market around 2017 and again after adjustments to the restrictive policies in 2022

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These estimates use BRFSS data but are averages over long time periods and do not provide the means to look at estimates for specific years or trends over time

The researchers put it plainly: "Dual users showed the greatest declines [in lung function] suggesting that combined exposure to cigarettes and e-cigarettes may have additive or synergistic effects on respiratory and psychosocial health." Dual use also keeps full cigarette exposure in place tar, carbon monoxide, and thousands of other chemicals produced by combustion instead of removing it

But smoking in 2017 is still the leading cause of preventable disease and death in the United States