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Questions to screen for tobacco and nicotine use include Do any of your friends use tobacco? Have you ever tried (name of tobacco product)? How often do you use (name of tobacco product)? Do your friends use hookahs, cigars, e-cigarettes, e-hookahs, or vapes? Have you tried hookahs, cigars, e-cigarettes, e-hookahs, or vapes? An algorithm for assessing severity of tobacco dependence appears in Table 27-2

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These oils crystalize on the wrapper creating a hazy light ashy powder