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For adult smokers to benefit from e-cigarettes, they must completely quit combusted tobacco. The changes to cigarette-sales trends such as the increases in traditional cigarette sales in some places could be the result of coincident macroeconomic changes, such as declines in gasoline prices and increases in disposable personal income. Other resources This 2016 study in the American Journal of Preventative Medicine looks at national and state data on electronic cigarette sales

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The geographical isolation of many reservations create logistical and cost challenges, limiting people's ability to access affordable nutritious food because they live far from large grocery stores