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In the last five years, congenital syphilis rates have increased precipitously among babies born to Native American, Pacific Islander, Hispanic/Latino, and Black Americans, due largely to a combination of rural health care strain and systemic racism, said Robert McDonald, a medical epidemiologist who works on syphilis prevention efforts at the CDC

This applies if you are importing it from out of country and if you're also coming into Japan and is irregardless of the nicotine strength

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The recent understanding of the harmful effects of smoking has created a pathway towards education and regulatory efforts aimed at reducing tobacco use [12,13]

This suggests that, at least in the long term, e-cigarette users do not end up smoking cigarettes