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Certain Indigenous communities also report higher engagement with smokeless tobacco products, including chewing tobacco, sometimes linked to accessibility and legacy consumption patterns
Funding This work was supported by the National Heart, Lung, and Blood Institute (R01 HL112212 to DEL), the National Institute on Drug Abuse (K01 DA042687 to KPR, R01 DA050482 to KPR, and R01 DA054935 to DEL), and the National Institute on Aging (R01 AG069575 to EPH) of the National Institutes of Health, the Agency for Healthcare Research and Quality (T32HS000063 to JEB), and the American Lung Association (Innovation Award IA-834584 to KPR)
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Furthermore, NNALa metabolite formed after 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) enters the body and a well known carcinogenurinary levels increased markedly after hookah use, indicating the presence of tobacco-specific nitrosamines in hookah smoke [63, 82]
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