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Although we cannot make causal inferences from these correlational data, the 2017 ATS provides some evidence in support of ENDS use as a potential gateway to smoking: 54% of current, former, and experimental smokers (see Table 2 for a summary of the four smoking status categories) who thought ENDS were available when they started smoking used ENDS before smoking a cigarette.

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However, some of this effect could be due to decreasing exposure to second-hand smoke in the reference group (never smokers) after the introduction of smoke-free legislation

This widening urban-rural divide can be partially attributed to tobacco marketing and pricing strategies