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The higher proportion of individuals who tried vaping at least once identified among smoking individuals with moderate or serious psychological distress, compared to those with no psychological distress, is consistent with previous findings in the general population regarding vaping and psychological distress, suggesting there is bi-directionality between mental illness and both types of nicotine delivery under study 22,23

Smoking means burning tobacco

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6 However, as many as 1 out of 4 Americans with COPD never smoked cigarettes

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"Tobacco standardised packaging"