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With coupons in nearly every mailer, the most obvious purpose of direct mail advertising is to promote use through reducing cost barriers, the authors write

Between 2017 and 2022, average nicotine concentration increased from below 2% to 5% in what has been dubbed the nicotine strength arms race. This trend of increasing nicotine strengths places youth at greater risk of addiction, lower motivation to quit, and amplified symptoms of anxiety and depression

Policy makers can formulate their decisions on smoking control priorities and resource allocation based on the magnitude of the effect and the consistency of the evidence relating smoking to each of the 36 outcomes, as represented by the ROS and star rating for each smokingoutcome association 187

Here is a breakdown of the most common cigarette pack sizes and formats you will encounter in the U.S