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A 2016 study E-cigarette users were also more likely to start smoking cigars, hookahs and pipes

however, the lower risk in Latinos and the higher risk in Native Hawaiians evidently cannot be explained using TNE as a measure of intensity

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Importantly, these increases are not observed in smoking-related inflammatory lung conditions such as emphysema or COPD, emphasizing the specificity of C4d as a biomarker for malignancy rather than for smoking-induced inflammation

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