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Tobacco use weakens the lower esophageal sphincter, increases stomach acid production, and impairs the esophaguss natural ability to clear acid, creating a perfect storm for persistent and worsening reflux symptoms

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The extent of nicotine absorption across membranes and nicotine-mediated harshness of inhaled aerosols, which may affect satisfaction and abuse liability for different tobacco products, depend on extent of protonation

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Phthalic acid esters (PAEs) are also known for their insecticidal properties due to reduced acetylcholinesterase enzyme activity