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From Babe Ruth to John Wayne, Americans have seen chewing tobacco in popular culture for over a century. Spitting chew has been a trademark of cowboys and professional athletes alike and chewing tobacco use continues at high rates in the United States. In 2018, a survey showed 2.4% of American adults used smokeless tobacco, with snuff or snus pouch use on the rise and chewing tobacco on the decline.

Though smokeless tobacco use is not associated with lung cancer like smoking is, it has its own set of potential dangers. First, smokeless tobacco does contain nicotine, causes nicotine addictio...