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Both habits carry significant health and societal concerns that deserve careful consideration.

Boston: Little, Brown, 1936

This catalyst effect, supported by findings that initial E-cigarette use predicts future smoking and that product initiation correlates with increased susceptibility to other products, means that pouch use might not only establish nicotine dependence but could also serve as a gateway to initiating or maintaining the use of other, potentially more harmful, products like cigarettes or E-cigarettes (30, 31)

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For 11 out of 14 regions, we used a large multi-country study (INTERHEART)conducted in 52 countriesto apply and deduce risk estimates