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Data extraction and quality assessment We did not attempt to contact the authors of any of the studies to request data or any additional information

Hindering FDA rulemaking efforts, the leadership and expert staff at FDA and its Center for Tobacco Products have been sharply diminished by the efforts of the Trump Administration and its unofficial Department of Government Efficiency (DOGE) to reduce personnel throughout the government, which started soon after President Trump took office in January 2025,[10] followed by efforts starting in April 2025 that were specifically targeted at further reducing leadership and other staff at FDA and other health agencies.[11] Among other staff removals, those FDA efforts prompted the Director of FDAs Center for Tobacco Products to leave government service and eliminated the Centers expert team in charge of drafting and revising rules.[12] Even if FDA, with its diminished capacity, were still able to organize and respond to all submitted public comments on the nicotine-reduction rule and prepare a final, legally valid version for possible implementation, it still could not release the final rule without clear White House support

The use of standardized methodology and questionnaires in all included countries allows for direct comparisons at the country level

Many important people lived in the Port Tobacco area