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In 1992, when the state anti-smoking effort started, 23.5 percent of Massachusetts residents lit up

Approximately 1.1% of women in the United States also reported to have used e-cigarettes during the last 3 months of pregnancy

reported that betel quid chewing, cigarette smoking and alcohol consumption were significantly related to oral cancer, which they suggested could be due to the carcinogenicity of alcoholic beverages, tobacco smoke and betel quid, with target organs including the oral cavity, pharynx, larynx and esophagus 16

Given the higher density of tobacco product retailers and people who smoke in urban areas, it seems likely that this is where the availability of alternative products would have a larger impact on consumer behavior that is measurable at the population level