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When Congress passed a law in 2009 effectively banning mail-order deliveries of cigarettes, it was expected to snuff out entrepreneurs on New Yorks Indian reservations who were selling millions of cartons, tax-free, to consumers in high-tax states

After a period of decline, many former tobacco buildings underwent adaptive reuse, and the former industrial sites became desirable for residences and new business

But the eventual death toll undoubtedly will be much higher among the one in four teenagers who now use devices like Juul, which distills 20 cigarettes worth of nicotine into one palatable pod

The study was investigator-initiated and investigator-driven