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[17] Since CYP2A6 activity differs by sex (estrogen induces CYP2A6) and genetic variation, cotinine accumulates in individuals with slower CYP2A6 activity, resulting in substantial differences in cotinine levels for a given tobacco exposure

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You can never infer causation from an observational trial, he said, adding that such trials are meant to point toward variables to explore. While low cases of smokers were reported, said Galiatsatos, smoking data has historically been flawed in how its captured in the hospital, which could be a confounder to this