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A shorter TTFC, such as smoking the first cigarette 30 minutes of waking consistently, predicts higher levels of nicotine metabolites, a greater exposure to carcinogens, and increased difficulty in achieving and maintaining long-term abstinence

Despite these public health victories, the downward trajectory of smoking rates has leveled off in the past 5 years

This creates a devastating onetwo punch: the alkalinity of slaked lime chews up the epithelial layer of buccal cells, enabling the carcinogens in the tobacco to reach into the inner layers where they cause DNA mutations

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