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Nine studies were restricted to never tobacco smokers, whereas two also included former smokers.7 8 Fixed effect meta-analyses of stratified results were done for four studies to obtain a summary relative risk.9 11 12 15 The nine independent risk estimates for myocardial infarction (table 1) resulted in a summary relative risk for ever use of smokeless tobacco products of 0.99 (95% confidence interval 0.89 to 1.10), with evidence of heterogeneity between studies (table 2

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Infants and young children , whose body temperature regulation is less effective