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(2) In reality, ECs contain several toxic and carcinogenic substances, such as heavy metals and different types of additives with attractive aromas and flavors, such as kiwi or peach, which facilitate the absorption of countless harmful substances, as well as new forms of nicotine, which are more addictive and which are not used in combustible cigarettes.(1) Dual use of combustible cigarettes and ECs is a prevalent behavior associated with a significantly increased risk of cardiovascular, cerebrovascular, and pulmonary diseases such as COPD and lung cancer, thereby contributing to elevated rates of premature mortality.(3-5) In 2021, The WHO estimated that there were 82 million EC users worldwide, EC use being more prevalent among children in the 13- to 15-year age bracket than among people in older age groups, as well as being more prevalent among boys than among girls.(6) Therefore, ECs are a new and major challenge for global public health