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Mediation was assessed separately for each outcome using the Karlson-Holm-Breen (KHB) method that extends the linear regression framework to the ordinal logistic regression framework 30

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While the industry is using the concepts of harm reduction and healthier alternatives to smoking to justify unregulated entry of these new and emerging nicotine and tobacco products into national markets, the truth is these products typically contain nicotine and other toxic substances that can have harmful impacts on brain development and long-term consequences, particularly for children and adolescents

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