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In these settings, smokeless tobacco use is often normalized as a discreet and durable option, especially in smoke-free environments

Wet-pipe - the default, and by far the most common in India In a wet-pipe system the pipes are permanently full of water under pressure, right up to every closed head

In more severe cases the condition can persist for years and lead to organ damage

The selection of appropriate cutoff values and consideration of the biomarkers detection periods play critical roles in verifying smoking abstinence or use, particularly in cross-sectional and longitudinal studies in tobacco harm reduction research