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Strengths of this study include the rigorous execution according to a pre-specified published protocol, as well as the randomized, controlled design
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Tobacco-specific nitrosamines (TSNAs), particularly N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), which are present at high concentrations in most smokeless tobacco products, are classified as carcinogenic to humans (Group 1) by the International Agency for Research on Cancer (28)
Firstly, it has been reported that waterpipe tobacco has a significantly higher nicotine content than cigarettes, with one head of shisha tobacco reportedly containing the nicotine equivalent of 70 cigarettes 43
