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Similar dysbiotic changes are observed in the respiratory and gastrointestinal systems, where smoking impairs mucosal immunity, increases oxidative stress, and compromises barrier integrity, thereby enhancing susceptibility to chronic diseases

[45] CALSPEAKS surveyed 622 likely voters on Proposition 56 in mid October 2016

But in a litigation environment where 155 fiduciary class action lawsuits were filed in a single year and the scope is actively expanding into health plans and voluntary benefits, a documented annual benchmark is one of the most practical and defensible steps a benefits team can take