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In Hawaii, roughly nine out of 10 smokers start before the age of 21 and many report receiving cigarettes from friends or relatives of legal age, according to the governors office

The idea here is that Americans have heard so often, and for so long, about how harmful cigarettes are that the message is less impactful. It may also be possible that fewer Americans know smokers or people with tobacco-related disease, and this also could decrease perceived harm

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Fast access and visible shelf placement still matter in cigarette purchasing

The ED may have additional drivers low testosterone, uncontrolled hypertension, diabetes, or significant arterial disease that quitting cannot reverse on its own

ODwyer DN, Kim JS, Ma SF, Ranjan P, Das P, Lipinski JH, et al