Theres also a psychological element at play
Start with a couple of pinches of tobacco, feeding them into the pipe, filling to a little over 1/4 of the bowl then very gently compress it with your tamper or finger
You're more likely to get it if your immune system isn't working well, perhaps because of cancer or HIV/AIDS
NIH: National Institute of Dental and Craniofacial Research Related Issues Health Effects of Smokeless Tobacco (Department of Health and Human Services) Properly Store Nicotine Pouches to Prevent Accidental Exposure to Children and Pets (Food and Drug Administration) Specifics Chewing Tobacco and Other Forms of Smokeless Tobacco Are More Harmful and Addictive Than You Might Think (Mayo Foundation for Medical Education and Research) Also in Spanish Clinical Trials ClinicalTrials.gov: Tobacco, Smokeless (National Institutes of Health) Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine) Article: Attention-deficit/hyperactivity disorder and snuff use prior to and early in pregnancy
Wu, Y., Fan, Z., Tian, Y., Liu, S