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More broadly, ETS exposure can be understood within the exposome paradigm, which emphasizes the cumulative impact of environmental exposures across the life course and their interaction with individual susceptibility and social determinants (6, 7)

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13 A company seeking to market an ENDS as an actual smoking cessation tool (i.e., with smoking cessation claims) such as the nicotine gum or patch would need FDA premarket approval as a drug, because smoking cessation claims trigger the first prong of the drug or device definition, described above