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The tribes argue that because they are sovereign nations, the cigarettes they make are exempt from the states $4.35-a-pack excise tax, the highest in the United States

What Research Shows What was concerning to researchers was that, according to a survey involving approximately 25,000 adolescents, most of those who had used e-cigarettes within the last 30 days reported starting out using closed systems and transitioning to open systems

The study, funded by Cancer Research UK and published in BMC Medicine, found that while overall smoking rates declined between 2013 and 2023, the proportion of women aged 18-45 from higher socioeconomic backgrounds who smoked rose from 12% to 15%

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