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Hence, these individuals might have experienced a small but steady increase in ANA prevalence across all time periods, which we speculate could be due to the steady decrease in their low-level CO protection from decreasing secondhand smoke (and possibly also from reduced exposure via air pollution ( Active smokers had high cotinine levels, which could result from either regular cigarettes or e-cigarettes, and would have been affected by changes in vaping but not secondhand smoke

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Year 2018, company introduced 8-sides sealed flat bottom bag machine

During use, the pouches are placed between the upper lip and gum, where nicotine is absorbed into the bloodstream through the buccal mucosa