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Athletes need to critically evaluate whether the short-term benefits of increased alertness and energy outweigh the long-term costs : The best performance enhancements come from training, nutrition, rest, and recoverynot from substances that promise short-term gains at a long-term cost

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Although we hypothesize that decreased CO and increased vaping may help explain both the changes in ANA time trends across smoking exposure levels and the changes in ANA associations with smoking across time periods, other factors may also have played a role