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In general, it is not clear if the upregulation or downregulation of antioxidant enzymes is positive or negative signal, but it is clear that smoking impairs the response and the ability of the antioxidant defense system to address acute and chronic oxidative stress

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[32] Unlike e-cigarettes, which vaporize nicotine-containing liquids, HTPs typically use leaf tobacco or another solid form, though some hybrid models can use both solid tobacco and e-liquids

Nicotine dependence is a specific form of substance use disorder recognized in medical literature

By 1979, the magnitude of the epidemiological, pathological, clinical, and experimental evidence had grown to the point that the Surgeon Generals Report concluded: Smoking is causally related to coronary heart disease in the common sense of that idea and for the purposes of preventive medicine. The Health Consequences of SmokingCardiovascular Disease: A Report of the Surgeon General