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According to this model, individuals with anxiety or depression may start or continue smoking to alleviate symptoms like sadness, tension, or irritability. Nicotine can provide short-term relief by temporarily boosting neurotransmitters such as dopamine and serotonin, which influence mood and reward. However, this relief is typically fleeting and may represent the alleviation of nicotine withdrawal rather than an improvement in underlying mental health

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There is evidence that kids and young adults may transition from these products to cigarettes and other drugs

Hawaii was excluded from the analysis because of insufficient data