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see Mok et al., 2026

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This effect may well occur, and one prospective study that investigated it in Jordanian youth (age 1316 years) suggests that tolerance may manifest itself not as increased waterpipe use but rather initiation and increasing use of tobacco cigarettes.106 If this form of cross-tolerance from waterpipe toward cigarettes is reliable and generalises to other populations, it further supports the idea that WTS is a grave and immediate public health threat

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However, the clinical sample size is small and the data is not sufficient