The authors admit this in the paper. They write: "This is a cross-sectional study, which only allows us to identify associations, not causal relationships."

First, the results demonstrate that many adults - in fact the majority of them - do prefer flavored e-cigarettes. Thus, it cannot be assumed that just because an electronic cigarette company markets flavored products, it is intentionally trying to recruit youth users. This is a flaw that many anti-smoking advocates and groups have fallen into. Because the market appears to be dominated by flavored products, it does not logically follow that any company which is marketing flavored e-cigarettes is trying to attract kids to vaping.

The randomized study provides a number of important benefits that can never be realized in a survey study. Most importantly, the RCT can equalize between study groups the known and unknown confounding variables that may lead to invalid study results.

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