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Following chronic PNE, high affinity nicotine binding in the neonatal and fetal brain is increased, providing evidence that nicotine reaches the fetal brain and upregulates nAChR receptors [3133]

Instead, strong tobacco policies in Tobacco Nation have failed to gain traction due to a combination of lack of political will to prioritize strong policies, tobacco industry interference in legislation, and state tobacco policies undercutting stronger local policies

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Several factors influence how this process works, as explained below

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