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Increasing use of ECs may have contributed to this change, though it is difficult to disentangle the impacts of ECs from those of other interventions such as annual tobacco tax increases and the implementation of standardised packs and enhanced health warnings in 2018

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So the appeal of Juul with its high-tech design is compounded by its addictiveness, said Michael Eriksen, dean of the school of public health at Georgia State University and a former director of the Centers for Disease Control and Preventions Office on Smoking and Health, and I think that explains the rapidity of the uptake. In 2017, the US market expanded by 40 percent to $1.16 billion, with a lot of that growth driven by Juul