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The five states with the highest percentage of high-school users were Wyoming (16.2%), North Dakota (15.3%), South Dakota (14.6%), Montana (14.6%), and West Virginia (14.4%)

"It's more difficult for them to quit because they're less likely to use counseling services and quit lines and pharmacotherapy, and that has to do with quit lines and counseling services not being really directed to their community," Garfield said