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Ramstrm, the director of the Institute for Tobacco Studies in Stockholm, and published in the British Dental Journal , the 2016 update to the Global Burden of Disease Study (GBD) found that the risk ratios (RRs) for developing oral and esophageal cancer due to the use of chewing tobacco were "significantly higher" than those associated with nasal snuff use

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[13] In addition, suicide attempts involving large quantities of nicotine-containing products have been reported as fatal