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National Institutes of Health has called smokeless tobacco one of the fastest growing detrimental health habits in North America as sports figures promote the product in an attempt to erase the old, unsanitary image of the habit and replace it with a macho image. Athletes, military personnel and people who find it difficult to smoke in their businesses tend to switch to smokeless tobacco, said Pamela Clark, a research professor at the department of behavioral and community health at the University of Maryland College Park

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The majority of patients that use tobacco want to quit, but without evidence-based treatment and support many quitting attempts fail