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As one of the first states to raise the tobacco purchase age to 21, Oregon still experienced a nearly 80% increase in youth e-cigarette use from 2017 to 2019

Cigarette smoking promotes acid reflux through multiple mechanisms including reduced lower esophageal sphincter pressure, increased transient sphincter relaxations, impaired esophageal clearance, and decreased saliva production

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These Z codes help indicate long-term risk even in the absence of current tobacco use, supporting proactive patient care planning