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We dont know what happens, over time, when you have varying strengths of nicotine sitting in your mouth in a pouch, Morean says

[ 4 ] While these rural-urban disparities in tobacco use are partly associated with certain sociodemographic risk factors characteristic to rural populations like employment status, income level, and educational attainment, when these sociodemographic risk factors are controlled for during analysis, the disparities in tobacco use and associated tobacco-related burdens still remain between rural and urban populations

Brion MJ, Victora C, Matijasevich A, Horta B, Anselmi L, Steer C et al (2010)

Int J Tuberc Lung Dis