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In a cross-sectional study of 7716 US adults from the National Health And Nutrition Examination Study cohort, Kempker [34] showed no effect on FEV1/FVC up to 20 joint-years, but in those with greater than 20 joint-years there was a 2.1-fold risk for FEV1/FVC ratio 40 years) residing in Vancouver, Canada, as part of the Burden of Obstructive Lung Diseases (BOLD) study [41], the odds ratio (OR) for chronic respiratory symptoms was not increased among the 49% of respondents who reported ever using marijuana alone and importantly the concurrent use of marijuana and tobacco was associated with a higher OR for respiratory symptoms (OR, 2.59

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Support of legislation that bans vaping in public places, increases pricing to discourage adolescent use, and other measures used successfully to decrease conventional cigarette smoking can be deployed to decrease the public health impact of e-cig arettes