Disposal of the juice involves spitting a practice early 19th-century Americans lustily engaged in, often without benefit of a spittoon
In young people, water pipe use increases with age but is low in all age groups
[PubMed Abstract] The Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff
Key strengths include the exceptionally large sample size, long follow-up, and detailed adjustment for clinical, behavioral, and socioeconomic confounders, allowing robust assessment of interactions between initiation age and smoking intensity
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Smoking remains one of the leading causes of lung cancer, chronic obstructive pulmonary disease, stroke, and cardiovascular disease