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While traditional cigarette use is declining, the CDC notes small increases in adult e-cigarette (vaping) use (2.8% in 2017 to 3.2% in 2018) even as the prevalence of e-cigarette use among high school students soars (20.8% who report past 30-day usage)

Compared to placebo, active cannabis reduced the actual dose of both cannabis ( p =0.035) and tobacco ( p once/month but 0.05)

This significantly reduces the surface area available for oxygen to enter the bloodstream, making it harder to breathe