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The nicotine is what creates the addiction and sustains it, but it's the method of getting that nicotine that causes the majority of the harm

The waterpipe, however, remained the most common smoking tool until the introduction of the cigarette in the 20th century

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Frank P, Morris J, Hazell M, Linehan M, Frank T (2006) Smoking, respiratory symptoms and likely asthma in young people: evidence from postal questionnaire surveys in the Wythenshawe Community Asthma Project (WYCAP)