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  • Three possible approaches are available: (1) to consider that any concentration resulting from a specific biomarker of SHSe such as nicotine, cotinine, or NNAL, indicates an increased risk [28]; (2) to classify exposure with respect to tertile or quartile of a general population of exposed individuals, if available (eg, US NHANES (serum) [80], England's Health Survey (saliva) [77],); and (3) to classify exposure severity based on known environmental exposure (eg, those heavily exposed in bars or casinos) or on association with disease (see Relationship of Biomarkers to Disease Risk).
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