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As a result of all that physical effort, the natural opening in the muscular diaphragm through which the esophagus passes is widened, creating a hiatal hernia

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Declines in smoking have slowed in recent years, making it unlikely that the nation will reach a public health goal of reducing the rate to 12 percent by 2010

Increased Health Risks: Long-term smokers not only face heightened risks of respiratory issues but also an elevated risk of cardiovascular diseases, various cancers, and other systemic health problems

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Data availability The datasets used and analyzed during the current research are available from the corresponding author upon request