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WHO Report on the Global Tobacco Epidemic: The MPOWER Package

In 12 states a region we call Tobacco Nation that spans Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia both adults and young adults have 50% higher smoking prevalence and smoke many more cigarettes per capita annually than people living in other states

One source from the 1990s titled Pipe Smoker

Smoking: Experts have revealed why cigarettes impact other areas of the body Researchers have sought to understand why smoking increases the risk of developing cancer in parts of the body that dont come into direct contact with smoke