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Likewise, plasma carboxyhemoglobin levels in hookah users exceeded those of cigarette smokers levels [61], indicating the presence/inhalation of carbon monoxide (CO) during hookah use

It is possible that for these individuals, the EC may have facilitated a lingering need for a change in behavior as it might have been stimulated subconsciously the progression through the stages of change (from pre-contemplation to contemplation to determination to action, i.e., quitting)

However, athletes continue to neglect smoking and pursue illegal and dangerous methods that have only minor and transient effects on the same physiologic variables