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Studies have detected diacetyl in up to 75% of flavored e-cigarettes tested, even in products labeled "diacetyl-free." The American Lung Association has expressed serious concern about these flavoring compounds and their potential to cause permanent respiratory damage

These design details make the packaging feel different from many international cigarette brands, which often use modern, minimal, or logo-led designs

Tindle said the study results highlight the need for stronger tobacco control measures and show why doctors should discuss smoking at every patient visit, encourage smokers to quit and inform them about effective ways to do so.

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