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States with a strong smoking culture, such as Kentucky and West Virginia, are gradually transitioning toward e-cigarettes, which are perceived as a less harmful alternative to traditional tobacco products

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Smoke is harmful to your health, and causes various health issues such as lung disease, heart disease, cancer, and other serious chronic diseases

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A detailed overall assessment of this aspect is beyond the scope of this paper, and ideally would involve direct comparison of risk in male and female smokers, with detailed adjustment for age, smoking characteristics and major potential confounding variables