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However, tobacco was probably used mainly for ritualistic and religious purposes and the evidence from the pipes proves that it had a long history in the beliefs of Native Americans

Thorndike, MD, MPH, suggested a third scenario as being more likely for young users: Teenagers who vape may never switch to smoking but will become nicotine-dependent adults who vape. With novel vaping technologies that deliver high doses of nicotine efficiently and cleanly, the gateway theory may be outdated, wrote Thorndike, with Massachusetts General Hospital and Harvard Medical School in Boston

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