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This occurred so rapidly and so early in the historic record that a complete understanding of in situ pre-contact smoking practices has been obscured, Tushingham and Gang write in their paper

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Other contributing factors include malnutrition, and a tracheocutaneous fistula

Tobacco related disparities also continue to impact the health of groups defined by race, ethnicity, educational level, and socioeconomic status and across Oklahoma

This occurred despite a substantial reduction in ST prevalence in India (constituting 70% of the disease burden) and little change in the disease risk estimates

Interferon Cytokine Res