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Users of high-voltage e-cigarettes need to be warned about this increased risk of harmful effects. Goniewicz recommended further research to examine other product characteristics that may impact toxicity, such as the types of heating elements, flavorings, additives and product storage conditions

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This finding supports the concept that commonly used indicators, such as the number of cigarettes smoked per day, are unreliable predictors of an individuals willingness to engage in smoking-cessation efforts 18,19