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[14] In response, Robin Sommers, the CEO and majority owner of Santa Fe Natural Tobacco Company, stated that "Native Americans are not a target market for American Spirit", stating that the use of this imagery was due to the company's goal to bring tobacco usage more in line with a perceived "moderation" by Indigenous peoples in the 15th century and that proceeds from sales support Native communities

Emphysema This refers to the destruction of tiny air sacs (alveoli) that allow oxygen into the bloodstream, leading to severe breathlessness and blackened lungs