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Some federal policies, like the 2009 Family Smoking Prevention and Tobacco Control Act and the 2019 amendment raising the age of sale for commercial tobacco products to 21 apply to retailers located both on and off Tribal lands

High exposure to polyaromatic hydrocarbons in the womb has been associated with lower IQ and childhood asthma, as well as adverse post-birth effects including heart malformations and DNA damage

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The chemical additives in commercial cigarettes (including ammonia, formaldehyde, benzene, and others) make tobacco smoke significantly more toxic than unprocessed plant smoke