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Maryland was a notable exception multiple pieces of legislation passed that increased the cigarette tax by $1.25 per pack and added e-cigarettes to the state smokefree workplace law as well as made other smaller improvements making the Free State the runaway winner of the most improved state in this years report, it said

However, public health campaigns and regulatory measures may influence future growth trajectories

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"Furthermore, some research suggests that adolescent smokers may experience more difficulty in quitting compared with adult smokers." The report also mentioned the Institute of Medicine concluded that raising the age limit to buy tobacco products to 21 would decrease use by 12 percent and lead to 225,000 fewer premature deaths, nearly 50,000 fewer deaths from lung cancer and almost 300,000 fewer pre-term births