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The use of tobacco also sees the state annually record 183 deaths per 100,000

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A 2023 review by Grabowska et al., called Recent Studies on the Development of Nicotine Abuse and Behavioral Changes Induced by Chronic Stress Depending on Gender revealed chronic stress heightens nicotine craving, amplifies perceived satisfaction from smoking and reinforces an unhealthy coping pattern

The study also reported stronger central adiposity (belly fat) in smokers, correlating with elevated cortisol secretion patterns

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However, this downward trend did not last