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One possible etiology is found in the flavorants added to the liquid, specifically diacetyl and 2,3-pentanediol, which have been shown to change gene expression of cilia on the bronchial epithelium in the respiratory mucosa (5)

Significant predictors of cigarette smoking in a binary logistic regression analysis with stepwise inclusion of the six independent variable groups: sociodemographic, work-related (organizational or general conditions), work-related (work-related impacts and attitudes), psychological, SARS-CoV-2-related, and health-related variables