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This is not only because smokers compensate by increasing inhalation leaving their smoke intake relatively unchanged, but also because a point is reached where reduced nicotine delivery meets with reduced consumer acceptance.[29] Dr Russells observations aside, there was little scientific support behind the idea that if nicotine could be successfully liberated from tobacco, the result could be a dramatic improvement in public health not least because substantial numbers of doctors believed nicotine caused cancer

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Gum disease is a serious health concern and has been linked with heart disease, stroke, difficulty controlling blood sugar, and tooth loss

Only 41.2 percent of packs had the proper California tax stamp, though a quarter of the sample had no cellophane on the package and no tax stamp whatsoever, making the origins of the pack indeterminate