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This is not limited to cigarettes the CDC explicitly notes that "products with nicotine raise your blood sugar," which includes pouches, patches, gum, and e-cigarettes

When she approaches the midwives about this, they refer her to a hospital where (after a very unpleasant and unfeeling examination by a doctor and a group of medical students) she discovers that she has "Testicular Feminisation Syndrome" (now called Androgen Insensitivity Syndrome), which occurs when the body of a person with XY chromosomes does not respond to masculinizing hormones, resulting in a typically "female" body

Some versions contain synthetic nicotine, while others are completely nicotine-free [8]

She wasn't made of stone

This makes the sustainability and waste control an afterthought