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The National Cancer Institute (NCI)

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We found that exposure to cigarettes, either as a passive or active smoker, affects the entire profiles of E2: the mean levels of E2 were significantly higher among the SM group compared with the nonexposed group, after controlling for age, PM10 and cycle length

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24 Thus, while the Natural American Spirit brand may be perceived broadly as healthier compared to other brands, 1416 the difference between pack colors within this brand may be negligible