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It is tempting, as a healthcare professional, to tell someone what you think they need to do

Epidemiologic research shows that people who use both alcohol and tobacco have much greater risks of developing cancers of the oral cavity (mouth), pharynx (throat), larynx, and esophagus than people who use either alcohol or tobacco alone

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But remember, this is a nation that pretty much looks past any kind of questionable behavior until we just can't handle it or the entire system collapses, and I guess spitting is way down the priority list behind slow play, club tossing and other golfing atrocities