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Tim McAfee, director of CDC's Office on Smoking and Health, told NBC News

We see a few roots show up often: Bullying scars that taught someone to stay quiet, stay agreeable, stay guarded Betrayal or criticism that made vulnerability feel risky Abusive dynamics where a person was controlled, shamed, or made to feel small Failure stories that quietly become identity: Im the one who messes up, Im not enough, I dont belong. Grief is another big one

That list does not include Indiana or Kentucky, but Indiana Senator Todd Young is among Hoosier legislators that want to see the smoking age increased to 21