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Nagy et al., 1997

While national cigarette consumption and smoking prevalence have each fallen ~30% over the lifetime of a cigarette butt (Fig 3), the interacting effects of population change, smoking prevalence, and behavior likely lead to local patterns diverging from the national trend

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But, at the same time, the ACA allowed insurers to charge substantially higher premiums to cigarette users, which increased out-of-pocket costs for smokers, reduced insurance enrollment among smokers, and, ultimately, produced no difference in rates of smoking cessation between 2013 and 2014 49

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