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Prevention programs should target not just legal substances but also marijuana use, as it shows stronger links to future illegal drug use compared to alcohol or tobacco alone

This is not a national prevalence estimate, but it is consistent with the broader pattern that many pouch users are previous users of cigarettes, vapes, or other nicotine products

Although, in most cases, detected levels of carbonyl compounds were lower than those in combustible tobacco cigarette smoke, very high levels of formaldehyde were also reported in e-cigarette aerosols (a comparison of toxicants from combustible tobacco cigarette smoke and e-cigarette aerosols is discussed in Chapter 18) (Canistro et al., 2017

It may be beneficial to involve a pulmonary specialist early in the management of this disease which is generally supportive care