what's in chewing tobacco use still high among airmen, surgeon general says Smokeless Tobacco
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it is responsible for an enormous burden of disease, death and economic cost in the United States

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The following is a closer examination of the mechanisms of smoking-induced conditions of the lungs: Tar and Toxins : The smoke that is released by the cigarette causes tar to form a coating on the alveoli (air sacs) that prevents the exchange of oxygen

But that only applies to large-scale smuggling