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This association was consistent even after adjusting the confounding effects of covariates

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Some adult participants who smoke combustible cigarettes developed counterarguments to claims of irreversible lung damage from smoking e-cigarettes ( psychological reactance ), and some adults who vape e-cigarettes indicated that warnings about the health effects of e-cigarettes on the body would not necessarily impact their use behavior ( defensive avoidance)

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The region continues to maintain a high volume of cigarette consumption due to entrenched cultural acceptance, urbanization, and population growth