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They point the finger primarily at gutka for India's 75,000 to 80,000 new cases of oral cancer a year, the highest in the world, according to the US-based Campaign for Tobacco-Free Kids

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However, compliance in only using research cigarettes in these trials is a concern [40], and although the extent of non-compliance was small for many participants, the feasibility of a nicotine reduction strategy depends on balancing the need for reducing dependence and the incidence of tobacco-related disease and minimizing the potential harms to smokers associated with withdrawal