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Leading scholars quantify Georgias economic losses at $1,059 in per person income, with a cumulative loss of $11.3 billion in income that could have otherwise been earned statewide in 2020.[5] Other studies on the federal workforce show that reductions in smoking rates are associated with fewer heart disease and stroke hospitalizations, lower worker absenteeism and higher productivity levels.[6] Simply put, reducing smoking rates and encouraging Georgians to avoid tobacco use is likely to reduce long-term health care costs and strengthen the states economy

Shamans used smoking or chewing tobacco in shamanistic rituals

PMID 29367307