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Smoking becomes less pleasurable, and smokers may need to increase their intake to get their "reward." A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine

Figure A2A-5 Average number of cigarettes smoked per day by daily smokers ages 15 to 25 (cigarette smokers only), total, according to sex and age, CoRolAR 2016 (Kuendig et al., 2017[5])

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38,39 This may reflect poor insight, denial of physical illness, unwillingness to see unfamiliar clinicians, difficulties navigating processes to access care, and not having transportation