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Although European studies do not support the association of CHD with SLT, there have been reports of higher mortality rate due to CHD in individuals switching from cigarettes to spit tobacco [hazard ratio (HR) 1.13, 95% CI 1.00-1.29] in multivariate model adjusted for the duration and number of cigarettes smoked per day before switching apart from other confounding factors53

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Recently, evidence has shown that efforts to avoid exposure to SHS do not provide sufficient protection against smoking substances