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For example, Appalachian youth are more likely to be exposed to tobacco products, live in communities where tobacco use is accepted, and use tobacco than other youth in the US 38-41

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Characteristic information is assessed using multiple questionnaires, assessments and tasks

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Nicotine absorbed through the oral mucosa disrupts neutrophil chemotaxis, impairs phagocytic activity, reduces fibroblast function, and limits revascularization and wound healing, all of which contribute to progressive attachment loss ( This study also highlights critical public health implications