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Thermal Reactions During Smoking As the charcoal warms the bowl, mild oxidation and Maillard reactions occur between sugars and amino acids

It is, by a wide margin, the leading cause of preventable death in the modern world

PMID:15986714

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The Stress Process Model further proposes that chronic stressors, including nicotine dependence, elevate psychological distress (depressive symptoms), which in turn increases disease risk through neuro-endocrine and inflammatory mechanisms