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37,38,41,42 Even the busiest of clinicians can serve an important role by spending approximately one minute per patient to identify tobacco users and to provide referrals to the quit line for more comprehensive counseling

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Genetics , with some individuals being more genetically predisposed to addiction due to differences in how their brain responds to nicotine

Plant Cell Environ 26:17231735

For example, a child could mistake a discarded nicotine pouch for something harmless, pick it up, and even put it in their mouth

While some of them, like Autumn Evening, can be found in a tin, I think bulk is just the natural starting point for a new smoker