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This means that the damage caused by a combination of these two risk factors is greater than that caused by either smoking or asbestos exposure alone

The health risks associated with second-hand smoke highlight the importance of creating smoke-free environments, reducing air pollution, and raising awareness about its dangers

Commercial tobacco is never used in ceremonies or for offerings, and many Indigenous elders maintain that the use of commercial tobacco is disrespectful to its spiritual and sacred value altogether

As to the rating, I give it a solid three

If you do it wrong and scald the back of your throat/tongue with the first draw you'll never touch it again and your pipe will soon be on ebay soon to be part of a very smug pipe smokers collection

doi:10.1037/a0015715