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continue to smoke at much higher rates including racial minorities like Native Americans, marginalized groups like the LGBTQI community, those who are less educated or living in poverty and those living in Southern and Midwestern states. ASHs report is consistent with the conclusions of a recent report from the Centers for Disease Control and Prevention, which states that nationally, the prevalence of cigarette smoking among adults living in rural counties is higher than in urban counties, and smoking rates differ markedly by region, making tobacco use a likely leading cause of differential mortality between urban and rural areas. So maybe it is not surprising that the U.S