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Health-care costs are the most immediate societal cost but there are productivity costs and losses due to the No

The study authors reported that, "In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of low-nitrosamine smokeless tobacco use." The authors concluded that "This finding raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking" [129]

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