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The authors noted that despite the lack of understanding of the long-term health impact of e-cigarette use, the contribution of current e-cigarette use to rising healthcare spending is significant and should not be overlooked. This excess spending is particularly relevant for employers, who cover over half of Americans through employer-sponsored health insurance

16 Coupled with large increases in state franchise fees on tobacco, Australia provided a unique context in which larger and larger pack sizes were introduced by tobacco companies

Race is also an important part of the American landscape, as America is made up of an amalgamation of races from all parts of the globe

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