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Cells lining the airways and alveoli include epithelial cells and alveolar macrophages, the latter being resident innate immune cells important in surfactant recycling, protection against bacterial invasion and modulation of lung immune homeostasis

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An integrated and overarching framework is needed within which the complex patterns of poly-tobacco and nicotine use behavior must be viewed [42, 53]

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Despite smokings devastating health and economic toll, few state or county health departments had programs or personnel dedicated to countering the tobacco pandemic