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More research is needed to confirm that. The lifetime health and economic burden of smokeless tobacco use in Bangladesh, India and Pakistan: results from ASTRAMOD, by Kathryn Coyle, Prashant Kumar Singh, Ravi Kaushik, Rumana Huque, Zohaib Khan, Ravi Mehrotra, Kamran Siddiqi and Subhash Pokhrel, is published today in Nicotine & Tobacco Research