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Public Health 37 , 625633 (2015)

Forty organizations hounded county lawmakers to curb what they say is an epidemic of youth addicted to nicotine, but those legislators couldn't produce the 20 votes Local Law E needed

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Zarda , a mixture of tobacco, lime, spices, and occasionally, silver flakes is also added to pan and chewed Khiwam , a mixture of tobacco extract, spices, and additives is a paste-like preparation that may be added to pan or chewed as it is Betel quid or pan contains four main ingredients, betel leaf ( Piper betel ), areca nut, catechu, slaked lime, and tobacco