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A recent survey suggested that in some regions, the organizations companies derived up to 79 percent of their business from tobacco products.

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In addition, NHIS collects information on the use of cigarettes and cigars only once at survey enrollment for each participant, and information on alcohol use and preexisting chronic conditions (e.g., diabetes, high blood pressure, high cholesterol), which are risk factors for premature death, was not available consistently after 1997 in NHIS

Nonetheless, 2.5 billion illegal cigarettes were consumed in 2024, resulting in 438 million in lost tax revenue , compared to over 620 million in 2023