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While some studies have not found a similar effect in Hepatitis B surface antigen (HBsAg)-seropositive patients regarding ALT levels, other research indicates an increased risk of cirrhosis in HBV carriers who smoke 20 or more cigarettes per day, an effect that is particularly pronounced when combined with habitual alcohol consumption [85, 86]

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As the age increase from 18 to 21 would make these products inaccessible to highschool seniors, who act as inlets of nicotine to younger grades, it would prevent even more potential health issues