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doi: 10.1.1.691.747

It is noteworthy that even among sets of twins where both are smokers, a difference in five years or more of smoking duration can cause visibly identifiable changes in facial aging, they wrote

One complication associated with chewing tobacco is an increased risk of several types of cancer, including bladder cancer

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While this decline reflects the general pattern of reduction in smoking-attributable mortality, the change did not reach statistical significance ( p = 0.148), likely due to substantial regional variations in the rate of decline