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Many of these products are smuggled from China, with one source estimating that Chinese counterfeiters produce 400 billion cigarettes per year to meet international demand.[11] Global focus on counterfeit cigarettes has forced the criminals to innovate

For example, a longitudinal analysis of a sample of young smokers in the US found that between 2019 and 2020, participants had 40% lower odds of reporting past 30-day cigarette use 26

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[221] It was described as "wide-ranging" and claimed that a range of factors, including diet, vaccinations, medical prescriptions, physical stress, food additives, and pesticides, are "potential drivers behind the rise in childhood chronic disease that present the clearest opportunities for progress"