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Though most nicotine pouches are considered tobacco-free because they are made with powder extracted from the plant instead of tobacco leaves, one 2022 study of 44 nicotine pouch products and two nicotine-free pouches found that more than 26 of the samples contained cancer-causing chemicals known as tobacco-specific nitrosamines (TSNAs)

All forms of tobacco use are harmful, and there is no safe level of exposure

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[30] During the act of smoking, plastic cellulose acetate fibers and tipping paper absorb a wide range of chemicals that are present in tobacco smoke