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In California, at least 150 residents have fallen ill and at least three have died, according to the California Department of Public Health

Tobacco cessation advice is often limited to doctors and nurses within primary healthcare settings 33 , with no clear plan to extend it to other disciplines from secondary or tertiary healthcare

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The earliest records come from Shumla Cave in Texas (Terry et al., 2006), where plant remains were discovered alongside other shamanic artifacts such as ritual deer scapula rattles, bone rods, scrapers, and incense-filled tubes