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It is widely acknowledged that smoking can have adverse effects on male reproductive health, including reduced sperm count and diminished semen quality 8,9,10,11

As smoking has become less socially acceptable in most of the US, rural communities, especially those economically reliant on tobacco, may still view it positively (51, 52)

In addition, there are recordkeeping requirements related to exported tobacco products

As the substance of nicotine is the most influential factor affecting health in vaping, turning to use a safer nicotine-free vape might help, without experiencing the painful withdrawal of nicotine while breastfeeding