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This is consistent with studies from the European Union 26,27 , the United States 28 , and Chile 30 , which found higher rates of flavored tobacco use in females, and a study from the United States which shows a higher prevalence of flavored tobacco use in certain ethnic groups (African and Hispanic) 28

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showed that serum TGF- levels in cigarette smokers with fractures were significantly reduced compared with non-smokers with bone fractures ( It seems that long-term waterpipe smoking, partly through the accumulation of nicotine in the body, decreased differentiation and proliferation through the reduction of VEGF, IGF-1, and TGF- and through vascular constriction, which reduces the bone blood flow and bone capacity to ossification following the fracture

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