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This neurobiological vulnerability, coupled with psychosocial factors such as peer influence, exposure to other drug users, and sensation-seeking traits, contributes to an elevated risk of transitioning from vaping to smoking and polysubstance use ( E-cigarette use among adolescents correlates with higher rates of alcohol, marijuana, and amphetamine consumption, as well as engagement in risky behaviors such as violence, unsafe sexual activity, and school misconductrisks amplified in dual users of both e-cigarettes and combustible cigarettes ( Encouragingly, recent surveys indicate a gradual shift in perception, with an increasing proportion of students now recognizing e-cigarettes as equally or more addictive than traditional cigarettes ( 3.2.6 The dual users phenomenon Based on the evidence analyzed in this review, between about 30% and 60% of e-cigarette users continues to smoke conventional cigarettes simultaneouslya pattern commonly referred to as dual use ( Dual users exhibit the highest prevalence of respiratory symptoms, including wheezing and asthma ( Beyond physiological effects, qualitative studies suggest that dual users may be driven by complex psychological and behavioral factors

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