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Professional voice users, including teachers, singers, and public speakers, may notice these changes earlier because of frequent vocal strain

There was a chemical in the blood and urine of those who smoked cigars, called cotinine, which is a chemical that takes the place of nicotine in the blood of those who smoke cigars instead of cigarettes

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Higher state cigarette taxes can have a final consequence, though it is difficult to quantify: smokers substituting cheaper "roll-your-own" cigarettes for commercial ones.[3] This "hand-rolled tobacco" may be smoked with or without a filter, thereby regulating the amount of nicotine according to the smoker's preference

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