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Carlson told me that he started using nicotine in June 1983

[ 6 ] In any case, the tobacco industry has, for years, aggressively marketed to rural populations and subpopulations, particularly through targeted advertising designed to link tobacco use with rural values and identities

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Given the importance of biofilm formation for adhesion in the oral cavity [70], and the fact that cigarette smoke increased biofilm formation by specific bacteria and promoted colonization [34], it would be reasonable to suspect that oral microbiome might be the missed connectivity between smoking and infective endocarditis