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PMID 27306725

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)

Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis

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