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Public health guidance is blunt about this

Furthermore, number of puffs, mean puff duration, puff volume, and inter-puff intervals were higher in hookah [22,23,24], in contrast to conventional smoking [25, 26]

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It could impact Pennsylvania in a very big, negative way, he said of the ban

The impact of exposure to tobacco smoke and e-cigarettes on asthma-related outcomes: systematic review informing the EAACI guidelines on environmental science for 324 allergic diseases and asthma