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According to SUCRA and P-score, dual use ranked highest for stroke risk (SUCRA=0.92 and P-score=0.93), followed by cigarette use (SUCRA=0.77 and P-score=0.76), e-cigarette use (SUCRA=0.45 and P-score=0.45), and former cigarette smoking (SUCRA=0.28 and P-score=0.29)

However, this research has limitations: It used lower nicotine concentrations than many modern products The study was relatively small and focused on rectal tone specifically It didn't account for higher-strength products like 6mg ZYN pouches Higher-strength products like 6mg or 9mg ZYN pouches contain substantially more nicotine and may produce stronger digestive responses

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