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Ethics statement All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Boards at the Johns Hopkins Bloomberg School of Public Health (#8817) and at the Instituto Nacional de Salud Pblica (#1582) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards

Some will disagree with this recommendation, as there has been an unnecessarily acrimonious debate within the public health community on harm reduction strategies based in use of smokeless tobacco products

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