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No concrete evidence of exactly what they smoked exists, but the most probable theory is that the tobacco was much stronger, consumed in extreme amounts, or was mixed with other, unknown psychoactive drugs

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However, multivariable logistic regression analysis revealed that, although differences in semen parameters and live birth outcomes were observed between cigarette types, key predictors of live birth, such as follicle-stimulating hormone (FSH) levels and the number of two-pronuclear (2PN) embryos, did not differ significantly between the groups

Alarmingly, close to 80% (78.5%) of these youth used at least one other tobacco product in addition to using nicotine pouches 5