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The bottom line, according to Alex Azar, the US secretary of health and human services, is that in the datasets we use, we have never seen use of any substance rise this rapidly. The percentage of high school-age children reporting past 30-day use of e-cigarettes rose by more than 75% between 2017 and 2018, while use among middle school-age kids increased nearly 50%, the National Youth Tobacco Survey showed

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