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Smokers also may be less likely to get cancer screening tests, the authors noted, so their disease is often further advanced when treatment begins

The authors put forward two theories to help explain the association: the self-medication hypothesis, suggesting that adolescents experiencing emotional distress such as loneliness may misperceive nicotine use as helpful in relieving negative feelings or improve mood (see Section 9A.3), and the social facilitation theory, proposing that nicotine use may help adolescents gain acceptance and a sense of belonging within peer groups when facing social exclusion

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Tobacco Control Legislation: An Introductory Guide