Adele's vocal fold nodules

There is speculation about how popular vocal artist Adele acquired nodules. Some believe is due to a chest dominant belt sound. However, other behaviors may have contributed to her pathology. She has stated that she has smoked and drank alcohol regularly. Adele also has a strong cockney accent. This accent involves many hard glottal sounds. Many singers have sung with a belt on broadway and not experienced any pathology. Perhaps we should consider her other behaviors could be the primary cause.