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I think especially in pregnancy, there's a high social desirability to not use any substances, and so patients are much less willing to disclose use in any setting, says Torri Metz, a maternal fetal medicine physician at University of Utah Health who was not involved in the study

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The high rate of naturalistic e-cigarette use in this group suggests that e-cigarettes are an appealing strategy to obtain nicotine during cessation treatment that could be harnessed as a smoking cessation tool or for harm reduction

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Without nicotine, a cigarette is just smoldering leaves wrapped in some fancy paper