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After the comment periods ended, the FDA reviewed and responded to thousands of comments for both rules, which was a lengthy process

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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

[9] This evidence is considered to be of the "moderate" level of certainty by a 2023 Cochrane Systematic Review, however, the safety profile was not clear in these studies as adverse effects were not well considered or properly reported