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they may be shredded, cut, or pressed into specific forms like plugs or twists
In 2025, the American Heart Association issued a policy statement on smokeless oral nicotine products concluding they are addictive and carry potential adverse effects on heart health
While advocates argues that the tobacco-free pouches deliver a a nicotine rush without the cancer risks associated with cigarettes, public health experts warn that they carry cardiovascular risks
However the authors said that if the adult man stopped smoking, or did not smoke at all, they could counter any risks
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