quitting tobacco can worsen mental health conditions with A Illness: What You Need to Know Quitting smoking is tough, but

The characters are coarse and earthy, the bawdiness is truly remarkable for a work of serious literature in that period, and the reader should prepare to be shocked, or at least respond somewhere on the range from mildly to severely disgusted from time to time

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SE=Substantial Equivalence

(Indeed, the Lesters and their connections are as animalistic a bunch as you'll encounter anywhere outside of a zoo.) It's also an example of a trend in portraying rural people, especially in the South (Appalachia was particularly liable to this treatment, but other areas were targeted as well, as here) as exaggerated grotesques, freaks who could properly be exhibited for the amusement and/or pleasurable horror of "normal" people who could afford to buy books

In 2013, Alliance One delivered approximately 19 percent of its tobacco sales to customers in the United States