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Long-term use increases the risk of death from heart disease and stroke

Most TRLs include a yearly fee, which generates revenue to help the city or county cover the costs of inspection and enforcement of minimum age laws, tax laws, and compliance with the Family Smoking Prevention and Tobacco Control Act

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[20] They are designed to be placed between the user's upper lip and gum, or between the gum and cheek, and used for up to one hour