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"By not prioritizing enforcement against other flavored ENDS products in the same way as flavored cartridge-based ENDS products," it says, "the FDA has attempted to balance the public health concerns related to youth use of ENDS products with considerations regarding addicted adult cigarette smokers who may try to use ENDS products to transition away from combustible tobacco products." Secretary of Health and Human Services Alex Azar, whose department includes the FDA, likewise says "our action today seeks to strike the right public health balance by maintaining e-cigarettes as a potential off-ramp for adults using combustible tobacco while ensuring these products don't provide an on-ramp to nicotine addiction for our youth." Technically, the FDA wants us to know, it is not imposing a ban on flavored e-cigarette cartridges, since "all ENDS products currently on the market are considered illegally marketed and are subject to enforcement, at any time, in the FDA's discretion." Rather, the FDA is using its enforcement discretion to target the products that are most popular with teenagers

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Second, smoking, stress, depression, anxiety, and HRQOL were measured by self-administered questionnaires, and the results may be affected by self-report and social expectation biases

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