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As of early 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that "there is general agreement that the number, size, and quality of studies for judging the effectiveness of e-cigarettes as cessation aids in comparison with cessation aids of proven efficacy are limited, and therefore there is insufficient evidence to permit a definitive conclusion at this time." 199 Further, the long-term health effects associated with use of ENDS are still largely unknown, 200 and FDA has not yet approved any ENDS products as cessation devices