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Instead, it is almost certainly a reflection of smokers obtaining their cigarettes (wittingly or otherwise) via tax evasion and avoidance

Virginia tax stamps made up another 21% according to the authors.[8] The majority (52%) of cigarette packs collected were menthol, a similar finding to a 2015 study.[9] Nearly half of these packs had no tax stamp

The authors meta-analysis included around 4 million individuals and 67000 coronary heart disease events from 86 studies

The report suggests that the biggest man-made contaminant of the worlds oceans is not plastic straws, or even plastic bags, but cigarette filters, or butts