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Research also indicates that American Spirit cigarettes contain similar or higher levels of carcinogenic nitrosamines and other harmful substances compared to other commercial brands

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The specifics have varied over the years, but you dont need too much imagination

Hazard ratios (HRs) or odds ratios were generated to analyze the effects of smoking at diagnosis on overall mortality (OM) and diseasespecific mortality (DSM) in a patient cohort from 13 disease sites containing at least 100 patients in each disease site

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Our findings were similar to those from Inoue-Choi et al