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Conclusions Although the ecological study design precludes conclusions on causality, the association between increases in manufactured cigarette price and the number of people smoking hand-rolling tobacco suggests that the lower cost of smoking hand-rolling tobacco encourages downtrading when cigarette prices rise

In utero exposure to nicotine, which is found in many vaping products, is known to directly harm fetuses by causing abnormal lung, heart, brain, and immune system development, which carries lifelong consequences." Robyn Horsager-Boehrer, M.D

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