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Studies examining sibling-pairs discordant for maternal smoking during pregnancy have also been conducted to control for familial vulnerabilities, either social or genetic, that predict risk of nicotine dependence [158, 159]

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Parental Involvement: Engage parents and caregivers in tobacco prevention efforts by providing information about the risks of tobacco use, modeling healthy behaviors, and establishing clear rules against smoking or using tobacco products in the home

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This reduces the chances of a sperm successfully fertilising an egg and causes lower fertility rates