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While possible changes in unrecorded tobacco supply are yet to be considered to determine changes in population level tobacco use, an upward trend would constitute a severe setback in reaching global goals to reduce smoking prevalence [51] and the attributable burden, both of which remain high in the European region [52, 53]

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However, realistic plans must also be taken into account that sustained cessation may not be achievable for many smokers, and alternative options should then be offered