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This behaviour is harmful and can lead to serious physical and mental health consequences

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Multiple lifestyle and psychosocial confounders are likely under-recognized cofactors in the association between smoking and IBD

4.1 Implications for prevention Given the substantial proportion of participants in the low-risk group and the limited differences between medium- and high-risk groupsaside from sexual activity under SU and prior exposure to psychological or sexual violencethese findings support the implementation of universal prevention interventions targeting adolescent SU in Costa Rica

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