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First, there is a common liability of use between combustible and e-cigarettes, meaning that there are common factors that drive people to use both combustible and e-cigarettes, but the two are not necessarily causally related

One study limitation, according to the researchers, is that the analyses were based on self-reported data on ENDS use and ED status, all of which are subject to misclassification and desirability bias (the possibility that respondents will answer questions based on what they think will be perceived favorably by others)