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"Some cigarette and smokeless packaging is changing, but the product remains the same," said one Phillip Morris flier distributed to retailers and specifically meant not to be shown to customers -- according to the paper

There has also been much less attention on the relationship between chewing tobacco and cardiovascular health outcomes, like ischemic heart disease and stroke, and the evidence that does exist has many of the same limitations as the data on cancer outcomes 8,14,15,16

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Similarly, Chen et al.30 did a cross-sectional study between the years of 1996 and 1997 assessing 73,364 Canadian individuals