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Sacred tobacco and American Indians, tradition and conflict American Indians have the highest smoking rates in the country: US commercialization of tobacco continues to complicate sacred use of the plant

Collectively, these two transitions are necessary for the overall initiation process, which involves transition from never combustible cigarette smoker to established or regular cigarette use (i.e., not merely temporary experimentation that does not progress to regular smoking)

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Recognising symptoms early gives treatment the best chance of success