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The nitrosation of nicotine as a result of metabolism gives rise to TSNAs, where N-nitrosonornicotine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone are the two most predominant forms and have been classified as group 1 carcinogens

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Smokeless tobacco can also lead to gum disease, heart disease, and precancerous mouth sores, among other health consequences

Additionally, chronic smoking is linked to other reproductive system diseases and complications

States like Florida have been motivated to increase their minimum age to purchase tobacco to 21 since Trump signed the federal standard into law in December 2019