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Cigarette smoking in the United States went up for the first time in two decades amid the persistent public health lobby against less harmful alternatives such as e-cigarettes and heated tobacco products, according to an international consumer advocacy group.

“Nothing has been more egregious and harmful in our current age than the public health lobby’s persistent denialism of the harm reduction value of nicotine vaping products and other alternatives to cigarettes,” Consumer Choice Center (CCC) deputy director Yaël Ossowski said in a blog post on the organization’s website.