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The resulting damage to the lungs is irreversible and over time can lead to severe lung conditions, including emphysema which is commonly found in chronic obstructive pulmonary disease (COPD)

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By mid-century, events impacting the use of cigarettes, such as the first Surgeon Generals Report on Cigarette Smoking in 1964 and the Tobacco Control Act in 2009, which banned flavors in cigarettes but not cigars, often produced notable, concomitant changes in cigar consumption (for more information, see Delnevo et al., 2017b)