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Casecontrol and cross-sectional studies also predominated, both which are problematic in terms of accounting for bias, such as failing to account for temporality of exposure and outcome, as well as former smoking status, rendering cross-sectional studies inappropriate for causal inferences

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So that's a concern, along with the effects of nicotine on the brain and the risk of becoming addicted. Allen and Foulds both said the results suggest that more can be done in Pennsylvania to help prevent children and adolescents from using these products

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