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Discussion This study is the first in Japan to examine the prevalence of use of combustible cigarettes and new tobacco-alternative products among adolescents

Genes and medical ailments are potentially involved, but most instances of hyperpigmentation of the lips are directly traceable to every-day habits and outside influences

It also notes the ongoing delay by the US Food and Drug Administration (FDA) in finalizing its review of pre-market tobacco product applications, along with the beginning of enforcement actions against unauthorized e-cigarette products