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According to Additional risk factors include: easy access to tobacco products peer and family influence, including lack of parental support or involvement mental health conditions, such as depression poor self-image or self-esteem negative life experiences, such as emotional abuse or parental separation substance use Many teens mistakenly believe that vaping, e-cigarettes, or hookah may not have negative health effects or lead to addiction

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Depression and smoking were assessed every six months along with factors such as parental smoking, familial support, temperament, delinquency, alcohol and substance use, and peer alcohol and substance use