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So this results in the heart having to work harder to get more blood to itself to work harder, because its working harder

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For additional information on state-level TRLs, see: CDC STATE System Licensure Fact Sheet American Heart Associations Tobacco Retail Licensure interactive map University of Maryland Legal Resource Centers 50 State Survey of Tobacco Licensing Requirements To find strategies for developing, implementing, and enforcing a comprehensive TRL policy, as well as local-level examples, review ChangeLab Solutions Tobacco Retailer Licensing Playbook