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[98] Comparisons of COPD rates between cities and rural areas can vary widely and tend to reflect underlying factors such as gender, smoking (rural people may smoke more), work-related pollutant exposure (grain dust and pesticides in rural areas, manufacturing in cities), and accessibility to health care

The Canadian government noted that some young people, who are particularly susceptible to the risk of tobacco dependence, start smoking after being given a single cigarette rather than a pack labeled with health warnings