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Nearly all 99 percent of smokers start smoking by age 26

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29 Screening patients for tobacco use, including ATPs, may be more challenging than for more traditional cigarette or smokeless tobacco products, because ATPs are not normally included on the medical history

Clinical data indicate that smoking adversely affects multiple aspects of liver disease, including the incidence and severity of hepatic steatosis, progression of fibrosis, development of HCC, and outcomes among alcohol-related liver transplant recipients [78, 79]