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This natural heterogeneity complicates efforts to isolate the specific effects of smoking, as it becomes difficult to discern whether observed changes in microbial composition are due to smoking itself or interactions between smoking and other factors

[10] She attended but did not complete studies at Sarah Lawrence College

Population studies cannot tell us whether nicotine itself caused the observed association, whether some other tobacco-related chemical mattered, or whether the finding was partly shaped by who seeks medical care, who receives a diagnosis, and who gets counted in the first place