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Further limitations of our study include not accounting for the potential synergistic eects of combined use of smokeless tobacco or areca nut products with other risk factors for oral cancer, such as tobacco smoking or alcohol consumption.4 Combined consumption of smokeless tobacco or areca nut, smoked tobacco, and alcohol has a multiplicative eect on oral cancer risk, with reported ORs increasing from 27 for smokeless tobacco only, 70 for smoked tobacco only, and 16 for alcohol only, to an OR of 162 for synergistic consumption of all Articles 10 www.thelancet.com/oncology Published online October 8, 2024 three exposures compared with abstainers.23 However, the proportion of people who chewed tobacco and also smoked in several countries with high smokeless tobacco or areca nut use was small

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The effects change in aerosol form