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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]

They can be glass, wood, plastic, ceramic, stainless steel, or a combination of these raw materials

Recent data shows that 11.5% of Americans smoked cigarettes in 2021 compared to 20.9% in 2005

That figure is consistent enough across US retail that its used in tax calculations, wholesale pricing and inventory tracking without much variation