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Few researchers have thrown light on possible acute autonomic effects[23,24] and hemodynamic changes of ST in the form of heart rate variability (HRV)[25,26,27,28,29] and various studies as well document the consequence of addictive qualities of ST often changing into lifelong habit with cumulative and more deleterious effects on health.[30,31] Despite the antiquity and popularity of gutkha chewing in India, its effects have not been investigated systematically in young adults

They can be used to symbolize a variety of things, such as addiction, rebellion, or mortality