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every year and the use of alcohol and tobacco particularly chewing tobacco or snuff greatly increases a persons risk of developing one (other risk factors include prolonged sun exposure and the human papilloma virus or HPV)

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This probably contributed to the reduction in smoking prevalence among women from less advantaged social grades and encouraged those who did not stop to switch to hand-rolled products as a way to afford to continue to smoke, the authors concluded

governments to take all possible action to control tobacco use and raise public awareness of the link between tobacco use and heart disease