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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

"Of course, Rose can't get anything straight," explains White

Smokers mortality rates are nearly 3 times greater than those of nonsmokers and essentially equal between men and women

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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)