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Heavy smoking, more cigarettes smoked, or higher nicotine content in the cigarettes can lead to higher cotinine levels

Through the work of government regulation and public health campaigns, smoking prevalence declined 4.1% in the decade between 2005 and 2015, according to the World Health Organisation

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Furthermore, in November 2017, major tobacco companies were mandated to sponsor and disseminate Federal court ordered Corrective Statements (CSs) advertisements in outlets such as newspapers and major television networks