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The PRISMA flow diagram ( and Literature Search Strategy ( are available as Supplemental Digital Content

Health and Safety of 16 and 17-Year-Old Child Workers Nearly all of the 16 and 17-year-old children interviewed25 out of 26reported feeling sick while working in tobacco farming in 2015, or after returning home from working in tobacco fields, with nausea, vomiting, headaches, dizziness, skin irritation, or respiratory symptoms

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Substances that significantly alter brain chemistry, particularly dopamine pathways, tend to be the most difficult to stop using