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If you use smokeless tobacco you are at increased risk for illnesses harming your mouth, such as cancer and gum disease

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This approach is inherently subject to potential recall bias, reporting bias, and misclassification in both exposure (product use and intensity) and outcomes (adverse events)

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However, the observed associations between vaping and subsequent cigarette smoking do not necessarily indicate a causal "gateway effect", as shared social, behavioral, or genetic risk factors may contribute to both behaviors