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Among men, the pooled relative risk for coronary heart disease was 1.48 for smoking one cigarette per day and 2.04 for 20 cigarettes per day, using all studies, but 1.74 and 2.27 among studies in which the relative risk had been adjusted for multiple confounders

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"A number of dairy owners in particular have reported significant hardship because they have chosen not to participate in what has become a very prevalent illegal tobacco sales network," Parmar said

If neither are available then a large gas syringe could be used