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A large longitudinal study published in BMJ Open in 2016 followed smokers over time rather than relying on peoples memories, and estimated the true average could be closer to 30, because earlier figures only counted people who had already succeeded and left out everyone still trying

Still, Chinas struggles stand out

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This direct exposure damages cells and increases the likelihood of mutations that can lead to cancer.The Nature Communications study highlighted that even moderate use of chewing tobacco over time can result in precancerous lesions and a faster progression to malignant tumors compared to cigarette smoking

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And it can have an almost universal understanding