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Over time, and with heavy smoking, those irritants make changes in the cells lining the surface (called epithelial cells)

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The absence of tobacco leaf itself makes these products a popular choice for those looking for nicotine alternatives that do not involve traditional tobacco use

They may also be especially sensitive to social-evaluative concerns, relying on close friendships as an important source of self-worth and self-evaluation (McCoy et al., 2017

Health effects of smoking in pregnancy Still birth (fetal loss at 20 weeks gestation or later) is a devastating complication of smoking in pregnancy