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In the European region, Greece, where awareness of e-cigarettes is the highest, females are 2.27 times more likely to use e-cigarettes than males

26 Availability of data and materials Not applicable

J Int Med Res

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Although the ASRs for smoking and secondhand smoke declined significantly from 1990 to 2021, and those for chewing tobacco remained stable, the absolute number of deaths and DALYs of most tobacco subtypes remains high and continued to increase, indicating a persistent and substantial public health burden