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ETS and active smoking have also been positively associated with congenital anomalies such as neural tube defects 5 , congenital heart defects 6 , and non-syndromic orofacial clefts (NSOFCs) 7-9

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Using data through 2023, our most recent estimates shows that California (53%), New York (52%), Massachusetts (38%), New Mexico (36%) and Washington (35%) have the highest inbound smuggling rates