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It is natural to equate one cigarette to a certain number of puffs, though this is rarely an exact science due to differences in individual inhalation depth, device power, and nicotine strength

20 How many packs in a carton of cigarettes

Health Policy 9 , 183196 (2011)

Others have pointed out that consistent epidemiologic data indicate that active smoking of some 45 cigarettes per day may not be associated with a significantly increased risk of lung cancer and since average doses of ETS to nonsmoking subjects in epidemiologic studies are several thousand times less than this reported intake level, the marginal relative risks of lung cancer and other diseases attributed to ETS in some epidemiologic studies are likely to be statistical artifacts, derived from unaccounted confounders and unavoidable bias [30]