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For instance, the fermenting process for cigars produces high levels of nitrosamines, which may cause cancer

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doi: 10.1097/00007890-199902150-00014

The majority of that was spent on healthcare ($240 billion)

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First cultivated by people in Central America an estimated 7,000 years ago, the plant spread to Europe when colonial trade was established across the Atlantic, making it an economic fixture of the American colonies and, eventually, the United States