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Philip Morris International, the world's second-largest tobacco company, reported a net revenue of $35.2 billion in 2023

The indigenous people of America also used snuff which was a fine aromatic powder composed of dried and thin leaves combined with tobacco, roots, peels, and seeds

The causal relationship of cigarette smoking to metabolic disease risk and the possible mediating role of gut microbiota

The nicotine and tar in these products stain teeth, turning them yellow or even brown over time

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Challenges: overcoming the inevitable The tobacco industry has vehemently opposed plain packaging,22 23 using multi-jurisdictional strategies including lobbying, organised opposition and front groups, public relations and media campaigns, and litigation.8 24 25 Each country will face its own obstacles, but strong political will, and the coalescing of civil society, advocates, public health and the medical profession can overcome these barriers.26 27 Furthermore, legal decisions in national and regional courts, and by World Trade Organisation panels established to arbitrate on disputes under bilateral and international trade agreements, have favoured plain packaging