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The fact that tobacco exposure appeared similar between combined smokers and tobacco-only smokers strengthens the argument that cannabis may be contributing something beyond tobacco alone, whether through its own direct carcinogenic effect or through additive pulmonary toxicity

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[7] Modern adaptations from craft-centric companies use fine and rare woods, bone, acrylic, aluminum, steel, titanium, other metals or plastics, adding features such as grinders, poker storage or lighter chambers