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The nicotine is released from the tobacco as the user "chews." Although chewing tobacco and snuff are considered smokeless tobacco products, harmful chemicals including nicotine are ingested

There have been numerous studies some of which are pointed to in articles like this one While certainly not risk-free, the risks are significantly less than cigarettes

These changes are driven largely by microscopic organisms and their ability to consume cellulose (starch) and create two important byproducts: sugar and carbon dioxide

This excludes all who had previously replied that they were using any other type of tobacco, or no tobacco