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Zhang L, Wang L, Li Y, Xia Y, Chang CM, et al

Visible white spots on the throat or white nodules on the throat near the tonsils

While ENDS may have the potential to benefit established adult smokers if used as a complete substitute for all smoked tobacco products, ENDS should not be used by youth and adult non-tobacco users because of the harmful effects of nicotine and other risk exposures, as well as the risk for progression to other forms of tobacco use. While 26 states and the District of Columbia have comprehensive smoke-free laws that prevent smoking in restaurants, worksites, and bars, only three of those states also prohibit ENDS use indoors: New Jersey, North Dakota, and Utah

Importantly, around 80% of subjects in the EC group were still using their EC product at the end of the study, illustrating that long-term nicotine replacement is likely a necessary condition to maintain smoking abstinence