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West Virginia remains a key state to watch as it continues to balance public health goals, particularly its status as the teen vaping capital, with its traditionally more moderate regulatory approach

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Several factors might explain this: (1) the arithmetic tasks may have served as distractors reducing the effectiveness of the smoking cues, (2) the stressful version of the task might have elicited near maximal responses that were not further augmented by exposure to the smoking cues, (3) habituation to the video cues from baseline to phase 1 could not be ruled out, but this was considered unlikely as novel videos were presented at each session and the expected cue-induced responses re-emerged during the follow-up sessions

The country has also extended cessation services beyond clinics and hospitals to reach out to more smokers