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Smoking-induced microbial dysbiosis impacts multiple anatomical sites, including the oral cavity, respiratory tract, and gastrointestinal system, driving disease progression through mechanisms such as immune modulation, chronic inflammation, and metabolic dysregulation

These include: Ashburnham, Athol, Blackstone, Bolton, Fitchburg, Grafton, Harvard, Holden, Hopedale, Lancaster, Mendon, Milford, Northboro, Shrewsbury, Southboro, Spencer, Westboro, West Boylston, Winchendon and Worcester

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4.3 million hectares of land are used to grow tobacco (2012) 90% of tobacco farming is in low- to middle- income countries, with the top being China, Brazil, and India

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