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Cotinine levels in saliva have been reported to increase with high nicotine concentrations in e-liquids, and significant cotinine levels have also been found in nicotine-free e-liquids [17]

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Similarly, in terms of respiratory health, studies have noted improvements in lung function and pulmonary ventilation and decreases in airway resistance among smokers who switched to e-cigarettes [41, 42], pointing to a potential benefit in reducing the harm caused by tobacco smoke

Or it was never their intention to become a real smoker, perceiving it as a socially-defined ritual from the start