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As one health worker commented, while chewing tobacco, during the focus group: It is better when you chew tobacco, because you are not exposed to the smoke. (phase 1: health worker, male, PHCC 1) While the dangers were covered in training, the challenges of overcoming these deep-rooted perceptions and social norms around chewing tobacco may have undermined implementation

They also smoke more: An average smoker in the 12 states goes through 53 packs of cigarettes in a year, while other Americans smoke 29 packs on average

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As most cancer-causing chemicals can only be found when a cigarette is burned, studies show that HNB devices are less harmful than combustible cigarettes