Dimension	Rating	Score	Explanation
Epidemiological Evidence	Strong	8/10	Multiple large national surveys consistently show association
Causal Evidence	Moderate	6/10	Longitudinal studies exist but causation not definitively established
Neurobiological Mechanism	Strong	8.5/10	Dopamine/serotonin disruption pathways well-characterized
Cessation Benefit Evidence	Strong	8/10	BMJ meta-analysis shows quitting ≈ antidepressant-level improvement
Adult-Specific Evidence	Weak-Moderate	5/10	Most research on adolescents; adult data extrapolated
Product-Specific Evidence	Weak	3.5/10	Studies rarely distinguish device types or nicotine concentrations