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A systematic review and meta-analysis of 50 randomized controlled trials of mostly US and European studies of school-based tobacco education programs found the combined social competence or social influences had been effective for reducing smoking initiation after any length of follow-up, and effective for the social competence curriculum after follow-up periods of more than 1 year 7

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Smoking increases the risk of cardiovascular disease, and poor cardiovascular health can disrupt blood flow and influence testosterone levels, impacting reproductive health in the long run

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