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Historical data indicates that smoking rates have fluctuated, but the negative effects on fertility remain consistent

For example, Virginia recently changed the definition of a cigarette in that state so that HeatSticks would not necessarily be considered cigarettes there (as they are federally)

Thus, accumulation of -ketoglutarate upon CSE treatment might lead to enhanced PHD activation resulting in increased HIF-degradation at least under hypoxia, where hydroxylated HIF-1 was increased by CSE