Furthermore, later in the paper they reinforce this point more specifically, writing: "the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa...".

Unfortunately, the Surgeon General's report conflated these two types of changes and as a result, its conclusion that the introduction of the filter actually increased cancer risk is inaccurate and in conflict with the scientific evidence.

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