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The pouches themselves are long and narrow, so fitting them under the lip is no problem

Dependence, physiological - condition in which the body relies upon a drug or substance, resulting in specific body cell alterations and in a state where continued use is necessary to maintain the body's state of normalcy and balance

This article first appeared in the 2025 edition of the PCA Almanac

Compare the two maps below: Heart Disease Death Rates Current Cigarette Use Among Adults SOURCE: Current Cigarette Smoking Among Adults in the United States