when did chewing tobacco become popular 20-Year Trends in Sales and Self-Reported Tobacco Use in the United States, 2000–2020 HISTORY OF TOBACCO - Chewing

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As specified, CMS determines aggregate growth in regional prospective HCC and demographic risk scores by calculating growth in prospective HCC and demographic risk scores between BY3 and the performance year for each Medicare enrollment type, where growth in an ACO's regional risk score by enrollment type is expressed as the ratio of the performance year regional risk score for a Medicare enrollment type to the BY3 regional risk score for that enrollment type

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There is potential that nicotine pouches are a better alternative to smoking, but we dont have the data to say that definitively