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Key findings Interpretation In this selected population with elevated hemoglobin, smoking is associated with higher hemoglobin levels and greater severity of polycythemia, with the strongest effect observed in combined cigarette and shisha users

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Limitations of the current research include the small number of studies, the small sample size, the evaluation mostly of first-generation devices, the limited investigation on which characteristics of the device and patterns of use (e.g., wattage, temperature) could be major contributors of exposure, and the evaluation of devices that are selected by the investigators but which do not necessarily reflect what the consumers are using

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