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"Smokeless tobacco and Cancer." Lancet Oncol Jul;9(7):667-75

The bans will be difficult to enforce, although Manfred has pledged to work closely with local law officials

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

[36] Separately, local policies have continued to expand tobacco-free rules at professional sports venues: in October 2025, the Detroit City Council approved an ordinance prohibiting smokeless tobacco (including nicotine pouches) in Detroit professional sports stadiums (including Comerica Park), with refusal to comply subject to a misdemeanor and a $100 fine

& Chandrasekaran, A