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The betel nut comes from the Areca palm and is in use by millions of people

Journal of the American Medical Association 266(22):3149-3153

Subjects were categorized according to the level of knowledge they had about the adverse effects of smoking: 1 correct response very low knowledge, 23 low knowledge, 45 reasonable, and 67 high level of knowledge (Supplementary file Figure 1)

Despite the misconception that its less harmful, hookah smoke contains harmful substances similar to those in cigarette smoke, including nicotine, tar, and heavy metals

Pan P, Shi H, Zhong J, Xiao P, Shen Y, Wu L, Song Y, He G

instead, we might helpfully see dual use on a trajectory to smoking cessation and support accordingly [26]