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In settings where smoking has historically been common and nicotine breaks are socially normalised, vaping may be added as a supplemental source of nicotine, particularly where smoke free rules restrict combustible use, offering a plausible pathway to dual use without implying a direct causal relationship [83]

However, it is often difficult to answer these questions due to a lack of evidence regarding their impact

doi:10.1016/j.toxrep.2020.10.017 53

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