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Evidence for trading up was found after the 2011 tax increase

Thus, prolonged or heavy use of hookah may induce risk of tumor development, especially in oral cavity and esophagus, which further argues against the notion that hookah has no/less harm if not inhaled kept in mouth. Indeed, incidence of benign lesions of the vocal cords was linked to the presence of cysts in 4.8% of hookah users, which was similar to cigarette smokers [134]

We assume this means according to the signage requirements outlined above

Approximately 43% of NHS trusts surveyed by ASH in 2020 reported commissioning specialist stop smoking support for pregnant women in 2020/21

These developments constitute a great victory against the powerful tobacco industry and highlight the importance of sharing good practices between countries