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New York is followed by California (44.0 percent), New Mexico (38.3 percent), Massachusetts (37.6 percent), and Washington (37.3 percent)

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The decline in smoking did not happen overnight

The reduced digestive impact of NRTs likely results from: Lower peak nicotine levels compared to cigarettes or snus More gradual nicotine absorption rates Absence of additional tobacco compounds that may affect digestion Steady release formulations (especially patches) that prevent nicotine spikes For people quitting smoking who are concerned about constipation, transitioning through nicotine pouches or gum before eliminating nicotine completely might help manage digestive changes more comfortably