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This research was supported by the National Institutes of Health through the National Institute on Drug Abuse of the National Institutes of Health (award P50DA036107) and the National Center for Advancing Translational Sciences through Penn State Clinical and Translational Science Institute (award UL1 TR000127)

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E-cigarette users exhibited markedly elevated respiratory symptom burden compared to controls, with a dose-response pattern suggesting potential temporal associations between exposure duration and symptom severity

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There was heterogeneity across states: five states spent more than 90% of recommended levels, and five states spent less than 10%