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Step 11 Now that the skull is beginning to take shape, we can add other patterns of smoke to it

Land & Water Use: Growing tobacco requires a huge irrigation system and thousands of acres of land that could have otherwise been used for growing food

A critical assessment of these manipulative tactics helps explain why, despite the overall US smoking rate decreasing to 11.5%, rates are much higher among people with lower levels of income and education, people who identify as American Indian/Alaska Native, men, people who identify as LGBTQ, people facing mental illness and disabilities, people who are uninsured or on Medicaid, and people living in the South and Midwest

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