Here, they find a correlation between e-cigarette use and higher and more sustained levels of smoking. But because this is a cross-sectional study, they cannot determine which came first. In other words, what is the direction of the causal relationship? Does the e-cigarette use precede, and cause, the smoking? Or does the smoking precede, and cause, the e-cigarette use?

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Stan writes: "Kelvin Choi and Jean Forester just published a of young adults that followed young adults in Minnesota for one year and examined how attitudes about e-cigarettes affected behavior. They report that one year after entering the study 7.4% of the young adults reported ever using e-cigarettes (21.6% among baseline current smokers, 11.9% among baseline former smokers, and 2.9% among baseline nonsmokers). Put another way, 11.9% of people who had quit smoking before the study started were using e-cigarettes at the end as were 2.9% of people who had never smoked. For these people, e-cigarettes were a pathway to renewed or new nicotine addiction."

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