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Ulcers in the mouth: The irritants in chewing tobacco can cause painful ulcers and sores in the mouth, increasing the risk of oral cancer

And I would say that there's another main piece at play, which is the emphasis on natural in a place like Vermont where there was a lot of hiking and connection to the land and a lot of, I moved to New York City after I was living in Vermont and just so different with the fashion, and I feel like a lot of people in Vermont, it's like flannels and more kind of hiking gear, whereas somewhere New York City is much more fashion forward

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"A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco"