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The first symptom is a desire to smoke which intensifies over time (DiFranza et al

The Washington State Healthy Youth Survey conducted in 2018 shows alarming statistics

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The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including: Nicotine Ultrafine particles that can be inhaled deep into the lungs Flavorings such as diacetyl, a chemical linked to a serious lung disease Volatile organic compounds Cancer-causing chemicals Heavy metals such as nickel, tin, and lead The Congressional Findings in the Tobacco Control Act, Surgeon Generals Reports, and other authoritative scientific studies have reported the following: Smoking costs the United States $193 billion every year from health care costs and lost productivity from premature death

Even if you skip the test, insurers can (and do) check background data later