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To the best of our knowledge, the present study marks the most up-to-date and comprehensive evaluation of the evidence underlying the health effects of chewing tobacco, specifically

this has the potential to amplify medical misinformation and discouragement of evidence-based treatment to new online audiences

Nationally, the e-cigarette use prevalence among high school students was 18%.2 In 2021, 2.7% of high school students in Texas used chewing tobacco, snuff or dip on at least one day in the past 30 days

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In general youth and young adults were more likely to select a pack as having an effect, rather than no difference, on their perceptions of harm and appeal in many of the areas assessed (see Additional file 3: Table S3)