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Confederate soldier Sam Watkins remembered that during the autumn 1862 retreat from Kentucky, soldiers got very thirsty for tobacco. Watkins and his fellow Tennesseans would cut the green sprouts off harvested stalks of tobacco and dry them by the fire and chew them. 40 Even more desperate were the efforts of Captain John Henry Otto of the 21st Wisconsin Infantry

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In addition, many studies rely on analytical approaches that do not fully account for the distributional characteristics of exposure data, such as excess zeros and overdispersion, which may lead to biased or unstable estimates (17, 18)

The research and ethics committee of Bellvitge University Hospital (LHospitalet de Llobregat, Barcelona, Spain) approved the study protocol and all participants signed an informed consent