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Although direct evidence on nicotines effects in the developing cardiovascular system is limited, its well established impact in adults particularly through sustained sympathetic activation and endothelial dysfunction raises credible concerns that early exposure during adolescence may disrupt normal cardiovascular maturation and contribute to the early development of risk factors for cardiovascular disease (9)

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[65] Additionally due to the overlapping jurisdiction of tribal, state, and federal authorities, enforcement of protection orders for victims remains largely unreliable