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The greater increase compared to smoking, as well as the protective associations for those who ceased use in the three months before their first visit (adjusted odds ratio 0.71 (0.441.14) for snus use and 0.88 (0.731.05) for smoking) make it difficult to interpret these results as causal

It acknowledges that tackling this inequality is the core challenge in the years ahead and that if England is to achieve being a smokefree society by 2030, bold action is required to both discourage people from starting in the first place and support smokers to quit