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I think especially in pregnancy, there's a high social desirability to not use any substances, and so patients are much less willing to disclose use in any setting, says Torri Metz, a maternal fetal medicine physician at University of Utah Health who was not involved in the study

Vaping is widely considered by UK public health bodies to be substantially less harmful than smoking

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"The big distribution point for Chinese, Uruguayan and Paraguayan cigarettes is Panama, said Rico, mentioning two countries also notorious for producing illicit smokes