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But according to the American Cancer Society, athletes are a large marketing source for smokeless tobacco, are often seen on TV using it and can influence youth to be more open to and accepting of smokeless tobacco. Heffner herself recalls mimicking the behavior of the baseball players she saw on TV when she was a young tomboy. I remember going to my Little League games and buying some Big League Chew [bubble gum] from the concession stand and practicing spitting in the dirt with my teammates, she said

Additionally, smokeless tobacco products may pose a low risk of cardiovascular disease, potentially increasing risk by 3-4% as opposed to smoking

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Usage has doubled annually since 2019, and overall sales exceeded 800 million units in the first three months of 2022, according to research published by the American Cancer Society

"When I started this research 20 years ago, I did not think that it would be a global problem