Statins Increase Risk for Medically Attended Acute Respiratory Illness

Statins Increase Risk for Medically Attended Acute Respiratory Illness

Elderly patients who have been inoculated with the influenza vaccine and who also use a statin are at a greater risk for medically attended acute respiratory illness.

Pneumococcal H Influenzae Protein D Conjugate Vaccine Effective in Children

Pneumococcal H Influenzae Protein D Conjugate Vaccine Effective in Children

The burden of childhood and infant pneumonia can be effectively reduced through the use of the pneumococcal Haemophilus influenzae protein D conjugate vaccine.

Pulmonary Symptoms With GERD in Infants May Increase Asthma Risk

Pulmonary Symptoms With GERD in Infants May Increase Asthma Risk

Infants who presented with pulmonary symptoms when diagnosed with gastroesophageal reflux disease had a higher incidence of early onset asthma compared with infants who did not have pulmonary symptoms.

Fluoroquinolones May Aid in Reducing Mortality in Community-Acquired Pneumonia

Fluoroquinolones May Aid in Reducing Mortality in Community-Acquired Pneumonia

For patients with CAP, antibiotic regimens including a fluoroquinolone may reduce mortality risk by 1-2% compared to beta-lactams and cephalosporins alone.

FDA Issues Safety Communication Regarding Pen Needle Use

FDA Issues Safety Communication Regarding Pen Needle Use

Standard pen needles have an outer cover and removable inner needle cover, while safety pen needles have an outer cover and a fixed inner needle shield that is not removed before an injection.

Adolescent Use of Combustible, Edible, and Vaporized Cannabis

Adolescent Use of Combustible, Edible, and Vaporized Cannabis

Combustible use was the most prevalent; 61.7% of cannabis users report using multiple methods.

Many Countries Failing on Noncommunicable Disease Death Targets

Many Countries Failing on Noncommunicable Disease Death Targets

For women and men, 35 and 30 countries expected to meet Sustainable Development Goal target 3.4

High Nicotine Concentrations Delivered by 'Pod Mods'

High Nicotine Concentrations Delivered by 'Pod Mods'

Small devices deliver addictive nicotine dose without noxious taste; pose danger to adolescents.

Facebook Program Did Not Increase Smoking Abstinence at 1 Year

Facebook Program Did Not Increase Smoking Abstinence at 1 Year

However, the intervention engaged young adults and increased abstinence at the end of 3-month treatment.

Climate Change: Dire Implications for Respiratory Conditions

Climate Change: Dire Implications for Respiratory Conditions

Changing pollination patterns, extreme weather events, rising sea levels, air pollution, and extreme temperatures all negatively affect respiratory conditions.

FDA Ad Campaign Hopes to Halt E-Cigarette Use in Teens

FDA Ad Campaign Hopes to Halt E-Cigarette Use in Teens

'The Real Cost' Youth E-Cigarette Prevention Campaign from the FDA is targeting at-risk youth.

Active Choice Intervention Tied to Increase in Flu Shot Rates

Active Choice Intervention Tied to Increase in Flu Shot Rates

Vaccination rates decreased throughout the day; with intervention, there was a similar increase throughout day.

Tips for Advising Patients Living in Highly Polluted Settings

Tips for Advising Patients Living in Highly Polluted Settings

Guidance focuses on Americans posted in overseas settings with high ambient levels of air pollution.

EPA Plan Will Maintain Carbon Emissions From Power Plants

EPA Plan Will Maintain Carbon Emissions From Power Plants

Inadequate regulation of carbon pollution will likely have current and future consequences for human health.

Infant PPI Use and Lung Infection Risk: Is There a Link?

Infant PPI Use and Lung Infection Risk: Is There a Link?

The data showed matched odds ratio for current vs past use of PPIs to be 0.88 (95% CI, 0.36 to 2.16) when comparing cases and their controls for community-acquired pneumonia. With regard to lower respiratory tract infections, the matched odds ratio between cases and their controls was 1.13 (95% CI, 0.87 to 1.48).

Many Middle, High Schoolers Report E-Cigarette Cannabis Use

Many Middle, High Schoolers Report E-Cigarette Cannabis Use

Electronic cigarette use is higher in male students and current users of e-cigarettes or other tobacco products.

Disaster Preparedness 101: Physician Resources for Patients

Disaster Preparedness 101: Physician Resources for Patients

The American Heart Association has updated their disaster resources page with the latest tips to keep in mind when counseling patients ahead of a natural disaster.

One in 7 US adults used marijuana in 2017

Adults aged 18 to 34 years had the highest frequency of marijuana use compared with all other age groups, and a small percentage of respondents reported using multiple different forms of marijuana per year.

E-cigarette use common, especially among younger adults and those in the LBGTQ community

When assessing age-specific groups, researchers observed that adults within the LBGTQ community, those with chronic health conditions, men, and current combustible cigarette smokers had higher rates of e-cigarette use.

Flavored E-Cigarette Product Sales Have Increased Since 2012

Flavored E-Cigarette Product Sales Have Increased Since 2012

Flavored products as a percent of all e-cigarette sales hit 19.8%; variations were seen by product type and state.

CDC: Tobacco Product Use Varies by Race in US Teens

CDC: Tobacco Product Use Varies by Race in US Teens

Highest use of tobacco seen in Native Hawaiians, Indians, Alaskans, and the lowest use in Asians.

FDA Gets Tough on Juul, Other Electronic Cigarette Makers

FDA Gets Tough on Juul, Other Electronic Cigarette Makers

More than 1200 warning letters and fines have been sent to retailers and major e-cigarette manufacturers.

Chronic Vaping Exerts Biological Effects on the Lung

Chronic Vaping Exerts Biological Effects on the Lung

On visual inspection by bronchoscopy, airways of e-cigarette users appeared friable and erythematous.

Immediate Nicotine Reduction Results in Bigger Cut in Smoke Exposure

Immediate Nicotine Reduction Results in Bigger Cut in Smoke Exposure

Smokers with immediate vs gradual reduction had significantly lower levels of smoke exposure.

Childhood Asthma Risk Assessed Using Respiratory Phenotypes

Childhood Asthma Risk Assessed Using Respiratory Phenotypes

Overall, 5 phenotypes were identified and differentiated mainly by patterns of wheezing and aeroallergen sensitization: low wheeze-low atopy, low wheeze-high atopy, transient wheeze-low atopy, high wheeze-low atopy, and high wheeze-high atopy.

Long-Term Mortality Risk Mitigated Through Midlife Cardiorespiratory Fitness

Long-Term Mortality Risk Mitigated Through Midlife Cardiorespiratory Fitness

The benefits of cardiorespiratory fitness extended well into the later part of life for middle-aged men without cardiovascular disease.

Nearly 15% of US Adults Used Marijuana in Past Year

Nearly 15% of US Adults Used Marijuana in Past Year

Prevalence of marijuana use was 20% in states with legal recreational use and 12% where no use is legal.

Chronic Vaping Exerts Biological Effects on Lungs

Chronic Vaping Exerts Biological Effects on Lungs

Approximately 300 proteins were differentially expressed in epithelial cells from biopsy samples in smoker and vaper airways, only 78 proteins were commonly altered in both groups, and 113 were uniquely altered in vapers.

ARDS Exacerbated by Low to Moderate Air Pollution in Severe Trauma

ARDS Exacerbated by Low to Moderate Air Pollution in Severe Trauma

Exposure to ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, and particulate matter <2.5 μm demonstrated strong associations with acute respiratory distress syndrome.

Electronic Cigarette Prevalence, Distribution in US Adults

Electronic Cigarette Prevalence, Distribution in US Adults

Increased prevalence of electronic cigarette use in younger adults, LGBT individuals, and combustible cigarette smokers.

Emphysema Associated With Worse Outcomes in Heart Failure

Emphysema Associated With Worse Outcomes in Heart Failure

After 2.1 years of follow-up, 49% of patients who had emphysema on chest CT were readmitted for heart failure and 24% had died.

CDC: Updated Influenza Vaccination Recommendations for 2018-2019

CDC: Updated Influenza Vaccination Recommendations for 2018-2019

In general, routine annual vaccination is recommended for all patients ≥6 months of age who have no contraindications.

Nonsmoking Teens Exposed to Tobacco Smoke at Risk for Related Symptoms

Nonsmoking Teens Exposed to Tobacco Smoke at Risk for Related Symptoms

Exposure in nonsmoking adolescents linked to increased risk for emergency department and/or urgent care visits.

Plan to Relax Coal-Fired Power Plant Rules Could Increase Mortality

Plan to Relax Coal-Fired Power Plant Rules Could Increase Mortality

EPA predicts between 470 and 1400 premature deaths a year by 2030.

Wildfire Smoke Causing Poor Air Quality in US Pacific Northwest

Wildfire Smoke Causing Poor Air Quality in US Pacific Northwest

Air pollution advisories and air quality alerts have been issued for Washington and Oregon.

Tobacco Content Still Common on UK Prime-Time Television

Tobacco Content Still Common on UK Prime-Time Television

Tobacco content occurred in 33% of all programs; 8% of all advertisements or trailer breaks.

E-Cigarette Vapor Condensate Toxic to Alveolar Macrophages

E-Cigarette Vapor Condensate Toxic to Alveolar Macrophages

E-cigarette vapor condensate is cytotoxic at lower concentrations than e-cigarette liquid, which results in increased apoptosis.

Will Lunar and Planet Dust Be Health Concerns of the Future?

Will Lunar and Planet Dust Be Health Concerns of the Future?

Prolonged exposure to planetary dust could impair airway and lung function and increase the risk of diseases like cancer.

Routine X-Ray Not Needed After US-Guided Central Line Insertion

Routine X-Ray Not Needed After US-Guided Central Line Insertion

There was a low risk of pneumothorax and catheter misplacement after a ultrasound-guided procedure.

Disparities Remain in Prevalence of Cancer Screening Tests

Disparities Remain in Prevalence of Cancer Screening Tests

From 2000 to 2015, individuals without insurance or usual care were less likely to have undergone cancer screening.

AMA Calls for Greater Electronic Cigarette Regulation

AMA Calls for Greater Electronic Cigarette Regulation

The American Medical Association urges federal government to regulate e-cigarettes, including a requirement to list nicotine content.

NHANES: Electronic Cigarette Trends in US Adolescents and Adults

NHANES: Electronic Cigarette Trends in US Adolescents and Adults

E-cigarette users had significantly higher odds of exposure to second-hand smoke and of consuming alcohol, after adjustments for age, gender, and ethnicity.

CDC: E-Cigarette Sales in the United States Climb as Prices Fall

CDC: E-Cigarette Sales in the United States Climb as Prices Fall

Average monthly sales of electronic cigarettes and related products rose 132% from 2012 to 2017.

FDA Releases Guidance on Nicotine Replacement Therapy Product Development

FDA Releases Guidance on Nicotine Replacement Therapy Product Development

The FDA aims to support the development of novel inhaled nicotine replacement therapies to combat the public health crisis of tobacco use in the United States.

FDA: Cancer Relapse Linked to Azithromycin Use to Prevent Serious Lung Condition

FDA: Cancer Relapse Linked to Azithromycin Use to Prevent Serious Lung Condition

Pfizer has terminated the ALLOZITHRO trial (N=480) due to this increased risk.

E-Cigarettes May Be Inadequate as a Smoking Cessation Tool

E-Cigarettes May Be Inadequate as a Smoking Cessation Tool

Dual users of conventional cigarettes and electronic cigarettes had the highest prevalence of respiratory symptoms.

Flu Vaccine Reduces Mortality in Rheumatoid Arthritis

Flu Vaccine Reduces Mortality in Rheumatoid Arthritis

Hospitalization risk was also reduced for RA patients who received influenza vaccination.

Reducing Computers in Surgical ICU May Cut Communication Barriers

Reducing Computers in Surgical ICU May Cut Communication Barriers

Reducing the number of computers in surgical intensive care units reduced barriers to communication.

Inappropriate Antibiotic Prescriptions Highest Among Urgent Care Facilities

Inappropriate Antibiotic Prescriptions Highest Among Urgent Care Facilities

Inappropriate antibiotic prescriptions were highest among urgent care facilities (45.7%), with emergency departments (24.6%), medical offices (17.0%), and retail clinics (14.4%) following.

Tobacco and Alcohol Consumption Tied to Cancer Mortality

Tobacco and Alcohol Consumption Tied to Cancer Mortality

Over 20 years, a 1-L reduction in alcohol intake was linked to a 3.9% decrease in overall cancer mortality.

H1N1 Immune Priming and Egg-Adaptation Affect Antibody Responses After Vaccination

H1N1 Immune Priming and Egg-Adaptation Affect Antibody Responses After Vaccination

Immune priming with seasonal H1N1 viruses earlier in life and egg-adaptation in vaccines can impact antibody responses following influenza vaccination.

Medicare Prescription Drug Plans Require More Out-of-Pocket Spending

Medicare Prescription Drug Plans Require More Out-of-Pocket Spending

Medicare beneficiaries spent more out of pocket for generic medications used to treat cardiovascular disease than patients using standalone prescription drug plans.

Interactions Between Organic Solvent Exposure, Smoking, and MS Susceptibility

Interactions Between Organic Solvent Exposure, Smoking, and MS Susceptibility

Researchers aim to assess the influence of organic solvent exposure on the risk for developing multiple sclerosis.

CDC: 'Tips' Campaign Has Helped a Number of Smokers Quit

CDC: 'Tips' Campaign Has Helped a Number of Smokers Quit

More than 9 million smokers have attempted to quit because of Tips from Former Smokers Campaign.

Smoking Marijuana May Increase Cough, Sputum Production, and Wheezing

Smoking Marijuana May Increase Cough, Sputum Production, and Wheezing

Results of a pooled analysis of cross-sectional studies demonstrated an increase in cough, sputum production, wheezing, and dyspnea from marijuana use.

Smoking Status Modified Obesity Paradox in Type 2 Diabetes

Smoking Status Modified Obesity Paradox in Type 2 Diabetes

Obesity paradox in type 2 diabetes was pronounced in current smokers and absent in never smokers.

CDC: Wildfire Smoke Poses Health Risks

CDC: Wildfire Smoke Poses Health Risks

The US Centers for Disease Control offers steps to minimize exposure to wildfire smoke, particularly for those with chronic conditions.

Blister Packs for Several Meds Recalled Due to Risk of Harm to Children

Blister Packs for Several Meds Recalled Due to Risk of Harm to Children

The recall affects approximately 470,000 units that include drugs packaged with 3 to 10 tablets per blister card. The blister packs were developed for use in hospitals, however some were sent to retail pharmacies and were likely dispensed for in-home use.

Tick-Caused Meat Allergy on the Rise in the United States

Tick-Caused Meat Allergy on the Rise in the United States

Lone star tick is most common in the South, but may be spreading to new areas.

Handheld, Wireless Ultrasound Device SONON 300L Now Available

Handheld, Wireless Ultrasound Device SONON 300L Now Available

The device is indicated for ultrasound echo imaging, measurement, and analysis of the human body for general clinical applications including musculoskeletal, vascular, small parts (breast, thyroid), and lung imaging.

WHO Calls for Renewed Effort to Combat Chronic Disease

WHO Calls for Renewed Effort to Combat Chronic Disease

Commission makes 6 recommendations to meet 2030 goals for non-communicable diseases.

NIH Warns of Increased Risk for Heat-Related Illness in Seniors

NIH Warns of Increased Risk for Heat-Related Illness in Seniors

Factors that could increase risk for heat-related illnesses include age-related changes to skin as well as heart, lung, and kidney diseases.

About 10% of Youth Report Smoking Hookah

About 10% of Youth Report Smoking Hookah

About 10 percent of youth report smoking hookah, with smoking mainly occurring in the home environment.

Smoking Marijuana May Be Tied to Cough, Sputum Production

Smoking Marijuana May Be Tied to Cough, Sputum Production

Smoking marijuana seems to be associated with increased risk of cough, sputum production, and wheezing.

Twitter Posts Reveal Use of JUUL Vaporizer by Minors at School

Twitter Posts Reveal Use of JUUL Vaporizer by Minors at School

Few JUUL-related Twitter posts mention topic of smoking cessation.

Prolonged Leisure-Time Sitting Tied to Increased COPD Mortality Risk

Prolonged Leisure-Time Sitting Tied to Increased COPD Mortality Risk

Increase in all-cause, cardiovascular disease, cancer, diabetes, kidney disease, suicide, and COPD mortality.

More Than 2000 US College Campuses Smoke-Free

More Than 2000 US College Campuses Smoke-Free

Of the more than 2000 US college campuses with smoke-free policies, 83.7% were tobacco-free and 79.6% and 41% had prohibited electronic cigarette use and hookah smoking, respectively.

E-Cigarettes May Help Some Quit Tobacco Smoking

E-Cigarettes May Help Some Quit Tobacco Smoking

Interviews showed some quitters deliberately switch from conventional cigarettes to e-cigarettes while some use both.

FIRS: Guidance Offered for Protecting Youth From E-Cigarettes

FIRS: Guidance Offered for Protecting Youth From E-Cigarettes

E-cigarettes should be regulated as tobacco products and their sale to youth should be banned worldwide, according to a statement from the Forum of International Respiratory Societies.

Misuse of Antibiotics Common in Outpatient Acute Respiratory Infections

Misuse of Antibiotics Common in Outpatient Acute Respiratory Infections

The researchers argued that outpatient antibiotic stewardship efforts must be strengthened to eliminate antibiotic treatment for viral upper respiratory infections and acute bronchitis.

Little Evidence Nicotine Preloading Helps Smokers Quit

Little Evidence Nicotine Preloading Helps Smokers Quit

Adjustment for varenicline use as a post-cessation treatment linked to increase in beneficial effect.

COPD Risk From Secondhand Smoke May Be Linked With Lung Volume Variations

COPD Risk From Secondhand Smoke May Be Linked With Lung Volume Variations

The inclusion of residual volume-to-total lung capacity ratio may add another dimension to COPD not routinely captured by standard airflow indices that could be predictive of lower maximum exercise capacity.

USPSTF Does Not Recommend Electrocardiography Screening in Low-Risk CVD

USPSTF Does Not Recommend Electrocardiography Screening in Low-Risk CVD

The United States Preventive Services Task Force does not recommend screening with resting or exercise electrocardiography in asymptomatic individuals at low risk for cardiovascular disease events.

2011 to 2017 Saw Decline in Youth Use of Any Tobacco Products

2011 to 2017 Saw Decline in Youth Use of Any Tobacco Products

Electronic cigarettes was the most commonly used tobacco product in high and middle school students in 2017.

AAFP Joins Call on FDA to Reduce Nicotine Content in Cigarettes

AAFP Joins Call on FDA to Reduce Nicotine Content in Cigarettes

The American Academy of Family Physicians and other signatories called on FDA to apply the proposal to other combustible tobacco products.

New Assays May Detect Early Lung Cancer in Blood

New Assays May Detect Early Lung Cancer in Blood

Targeted sequencing, whole-genome sequencing, and whole-genome bisulfite sequencing showed potential for detecting lung cancer.

Indeterminate Pulmonary Nodules Characterized by CT-Based Radiomic Classifier

Indeterminate Pulmonary Nodules Characterized by CT-Based Radiomic Classifier

A total of 8 quantitative radiologic features were used to characterize indeterminate screen-detected lung nodules.

Factors Associated With Stronger Nicotine Dependence in Adolescent E-Cigarette Users

Factors Associated With Stronger Nicotine Dependence in Adolescent E-Cigarette Users

In adolescent e-cigarette users, stronger nicotine dependence was associated with being in a higher grade in school, vaping at an earlier age, vaping more frequently, and the use of higher nicotine concentrations.

Relationship Between Smoking Behaviors and BMI, Waist Circumference, Adiposity

Relationship Between Smoking Behaviors and BMI, Waist Circumference, Adiposity

Body mass index and body fat distribution may influence smoking behaviors.

Delaying Lactate Draws in Sepsis Increases In-Hospital Death Risk

Delaying Lactate Draws in Sepsis Increases In-Hospital Death Risk

Systematic early lactate measurements speed antibiotic administration and improve outcomes in patients with sepsis.

Mediterranean Diet May Lessen Adverse Effect of Air Pollution

Mediterranean Diet May Lessen Adverse Effect of Air Pollution

Adherence to Mediterranean diet may attenuate association of nitrous oxide with all-cause mortality.

Financial Incentives May Increase Rates of Smoker Abstinence

Financial Incentives May Increase Rates of Smoker Abstinence

Redeemable deposits and rewards were superior to free smoking cessation aids with respect to sustained abstinence.

E-Cigarette Flavoring Agent May Impair Airway Defense System

E-Cigarette Flavoring Agent May Impair Airway Defense System

Flavoring commonly used in e-cigarettes suppresses cilia beat frequency, lasting for 60 minutes.

Higher Adiposity Increases Odds of Smoking

Higher Adiposity Increases Odds of Smoking

Obesity may be linked with an increased risk of smoking as well as an increase in the number of cigarettes smoked per day.

Marijuana Smoking Associated With Rapid Decline in FEV1 for Older Adults

Marijuana Smoking Associated With Rapid Decline in FEV1 for Older Adults

Researchers examined the relationship between smoking marijuana and the decline in FEV1 in adults aged 40 years and older.

Maternal Exposure to Polluted Air Tied to Elevated Child BP

Maternal Exposure to Polluted Air Tied to Elevated Child BP

Overall, there was a 1.61-fold increase in risk for elevated blood pressure in children with highest vs lowest tertile of PM2.5.

Child Secondhand Pot, Tobacco Exposure Increases ED Visit Risk

Child Secondhand Pot, Tobacco Exposure Increases ED Visit Risk

Children with exposure to secondhand marijuana and tobacco smoke have an increased rate of emergency department visits.

Early Readmissions More Preventable Than Later Ones

Early Readmissions More Preventable Than Later Ones

General medicine readmissions within 7 days were more amendable to hospital-based interventions.

The Unintended Consequences of Cigarette Taxation

The Unintended Consequences of Cigarette Taxation

Although cigarette taxes were supposedly implemented to encourage smokers to quit, they can have a disproportionate effect on people of low-income status.

Flu Vaccines Have High Impact, Even With Relatively Low Efficacy

Flu Vaccines Have High Impact, Even With Relatively Low Efficacy

A high impact was seen, especially when the vaccine uptake was optimally distributed across age groups.

Liquid Nicotine Exposure in Children Declining, But Still a Threat

Liquid Nicotine Exposure in Children Declining, But Still a Threat

The rate of liquid nicotine exposure in children younger than 6 years of age has declined since 2015, but it continues to pose a serious poisoning risk.

Improvement in Race-Based Disparities in Years of Life Lost

Improvement in Race-Based Disparities in Years of Life Lost

Decline was observed in race-based disparities in years of life lost in the United States from 1990 to 2014.

April 28 Is Drug Take Back Day

April 28 Is Drug Take Back Day

April 28, 2018 is National Prescription Drug Take Back Day.

Smoking Cessation Pharmacotherapies May Not Increase MACE

Smoking Cessation Pharmacotherapies May Not Increase MACE

There were no observable differences in the incidence of any cardiovascular events across the smoking cessation treatment groups.

E-Cigarette Use Tied to Subsequent Marijuana Use in Teens

E-Cigarette Use Tied to Subsequent Marijuana Use in Teens

Stronger correlation was seen between electronic cigarette use and marijuana in younger adolescents, aged 12 to 14 years, than for older teens.

FDA Announces New Initiative Aimed at Stopping Youth Use of E-Cigarettes

FDA Announces New Initiative Aimed at Stopping Youth Use of E-Cigarettes

In a wide ranging statement, the FDA commissioner Scott Gottlieb, MD, specifically targets novel nicotine-delivery products as being problematic since many of these devices resemble USB flash drives, have high nicotine levels and have emissions that are hard to see.

ACOG: Updated Recommendations for Influenza Vaccination During Pregnancy

ACOG: Updated Recommendations for Influenza Vaccination During Pregnancy

This updated Committee Opinion includes more recent data on the safety and efficacy of influenza vaccination during pregnancy, as well as recommendations for treatment and postexposure chemoprophylaxis.

Decreased Lung Function More Prevalent in Preterm Born Children

Decreased Lung Function More Prevalent in Preterm Born Children

Children who were born preterm had an increased likelihood of developing impaired lung function compared with healthy term children.

Number of Cigarettes Smoked Daily Tied to Stroke Risk

Number of Cigarettes Smoked Daily Tied to Stroke Risk

In men younger than 50, the more cigarettes smoked linked to increased risk for ischemic stroke.

COPD Risk in Middle-Age: The 3-Way Interaction of Asthma, Smoking, and Measles

COPD Risk in Middle-Age: The 3-Way Interaction of Asthma, Smoking, and Measles

A childhood measles infection may increase the risk for post-bronchodilator airflow obstruction in middle-age adults via its interaction with asthma and smoking.

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