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Repeated exposure to small amounts of smoke over a long career, especially without the protection of a self-contained breathing apparatus (SCBA), can have cumulative and life-ending consequences

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4 As patterns of use increase, nicotine causes more significant changes in brain neural circuitry, resulting in a lower sensitivity to nicotines aversive properties, and reinforcing the pathways that drive regular intake, e.g

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Associations between tobacco smoking and e-cigarette use and respiratory symptoms The prevalence of all respiratory symptoms at follow-up was highest among persistent smokers who used e-cigarettes compared to never smokers, quitters and persistent smokers who did not use e-cigarettes (Figure 3)