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Archeological studies suggest that the Maya people of Central America started using tobacco leaves as far back as the 1st century BC, mainly for smoking in sacred and religious ceremonies

Am J Transl Res

However, they are still under the jurisdiction of the FDA as of 2016, when it was ruled that ENDs fall under the category of tobacco products

The mechanisms behind these associations suggest that oral bacteria and their metabolites can enter the bloodstream through oral epithelial barriers or via direct interactions with the respiratory and digestive systems, thereby influencing systemic health [33,34,35]

The administration did not give its reasons for delaying the rule