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"An 18-year-old high school student can legally buy cigarettes or other nicotine products and give them or re-sell them to underage classmates," Buzby wrote in an email to the Free Press

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In the Eastern Mediterranean Region 38% of students aged 1315 are exposed to second-hand smoke at home, and in many countries only around a quarter of homes are smoke-free

The idea here is that Americans have heard so often, and for so long, about how harmful cigarettes are that the message is less impactful. It may also be possible that fewer Americans know smokers or people with tobacco-related disease, and this also could decrease perceived harm