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First, participants of these focus groups represented 16 US states, which, given the variability of T21 implementation and enforcement based on location, may have influenced the results of this study

Counties in regions such as the U.S.-Mexico Border, Black Belt Region, American Indian/Alaska Native (AI/AN) tribal areas and their surrounding counties, and Appalachia experiencing these forms of structural racism and disinvestment are often more rural and have a greater percentage of the population of color than the U.S., on average

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Given the high prevalence of e-cigarette use among pregnant women who smoke cigarettes and potential for heightened risks 17 , dual users represent an optimal sample for the present analysis