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Industry players have invested heavily in research to show that noncombustible products present much lower exposure to toxic substances than conventional cigarettes

Illinois neighborsIndiana, Iowa, Kentucky, and Wisconsinall saw an increase in outbound smuggling

Lancet Reg Health Am

Thus, prolonged or heavy use of hookah may induce risk of tumor development, especially in oral cavity and esophagus, which further argues against the notion that hookah has no/less harm if not inhaled kept in mouth. Indeed, incidence of benign lesions of the vocal cords was linked to the presence of cysts in 4.8% of hookah users, which was similar to cigarette smokers [134]

[21] Since 2019, the smoking age in South Carolina has been 21 under federal law