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"It's also concerning because some of the ways that they have been prepared, such as using flavors, may make them particularly appealing to younger people." Goldstein noted that "epidemiologically, there's concern for increasing stroke risk in young adults." And because there was almost a doubling in the use of regular cigarette smoking in the e-cigarette users in the current study, there may be "a wave of cardiovascular disease that may be coming in the future, especially since this has been so attractive to young users." Although he reiterated his questions about unmeasured confounding in the study and also stressed that the results showed an association and not causation, Goldstein said the findings support that there are warning flags and added that more data is needed