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In 12 states a region we call Tobacco Nation that spans Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia both adults and young adults have 50% higher smoking prevalence and smoke many more cigarettes per capita annually than people living in other states

Ethics declarations Competing interests The authors declare no competing interests

A far cry from the custom Printing Products brands rely on today

Tobacco advertising is banned on television and radio and cigarette packs are required to carry health warnings but the warning on cigarettes packs are small and not very explicit

"ABC of chronic obstructive pulmonary disease