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That shift, combined with the rise in pouch popularity, led me to gradually shift over to pouches. Althoff, whos in her 20s, said there was a very noticeable culture shift among women in her generationthat younger women were skipping the smoking stage of peer pressure altogether, and moving straight to pouches

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J Natl Cancer Inst (2004) 96:84452.10.1093/jnci/djh163 18 CarmellaSGHanSFristadAYangYHechtSS

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doi: 10.1378/chest.128.4.2068