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Government Accountability Office reported in 2025 that because pipe tobacco is taxed at a lower rate than roll-your-own tobacco, consumers who hand roll cigarettes may have an incentive to use pipe tobacco, and that manufacturers also had an incentive to relabel products as pipe tobacco

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Bellin MD, Beilman GJ, Sutherland DE, et al

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Lancet 370:765773 U.S

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)