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Surprisingly, in fully legal (versus illegal) states, the likelihood of reporting recreational use was significantly lower while the probability of reporting both [medical and recreational] reasons was significantly higher. Why

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Cigarette smoke disrupts gutlung axis communication through microbial metabolite alterations driving pulmonary inflammation and cancer progression Interestingly, accumulating investigations demonstrate that cigarette smoke distorts gutlung axis communication by altering microbial metabolite profiles, creating a pro-inflammatory milieu that fuels pulmonary deterioration in COPD and promotes oncogenic niches in lung adenocarcinoma (LUAD)

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"Advocates Say Smoke-Free Eventually May Result from More Curbs, Taxes on Tobacco Use." JAMA, February 10, 1993, p