Exposure to Nicotine and Selected Toxicants in Cigarette Smokers Who Switched to Electronic Cigarettes: A Longitudinal Within-Subjects Observational Study

A newly released study has now again proven what many of us were already aware of.  Smokers switching to vaping devices that contain nicotine but not tobacco will remove the deadly toxins found in tobacco cigarettes.   This will go a long way toward the fight for vaping as a safer alternative to tobacco.  It will hopeful help doctors to continue recommending vaping and vape

Abstract

Introduction: Electronic cigarettes (e-cigarettes) are purported to deliver nicotine aerosol without any toxic combustion products present in tobacco smoke. In this longitudinal within-subjects observational study, we evaluated the effects of e-cigarettes on nicotine delivery and exposure to selected carcinogens and toxicants.

Methods: We measured seven nicotine metabolites and 17 tobacco smoke exposure biomarkers in the urine samples of 20 smokers collected before and after switching to pen-style M201 e-cigarettes for 2 weeks. Biomarkers were metabolites of 13 major carcinogens and toxicants in cigarette smoke: one tobacco-specific nitrosamine (NNK), eight volatile organic compounds (1,3-butadiene, crotonaldehyde, acrolein, benzene, acrylamide, acrylonitrile, ethylene oxide, and propylene oxide), and four polycyclic aromatic hydrocarbons (naphthalene, fluorene, phenanthrene, and pyrene). Changes in urine biomarkers concentration were tested using repeated measures analysis of variance.

Results: In total, 45% of participants reported complete abstinence from cigarette smoking at 2 weeks, while 55% reported continued smoking. Levels of total nicotine and some polycyclic aromatic hydrocarbon metabolites did not change after switching from tobacco to e-cigarettes. All other biomarkers significantly decreased after 1 week of using e-cigarettes (p < .05). After 1 week, the greatest percentage reductions in biomarkers levels were observed for metabolites of 1,3-butadiene, benzene, and acrylonitrile. Total NNAL, a metabolite of NNK, declined by 57% and 64% after 1 and 2 weeks, respectively, while 3-hydroxyfluorene levels declined by 46% at week 1, and 34% at week 2.

Conclusions: After switching from tobacco to e-cigarettes, nicotine exposure remains unchanged, while exposure to selected carcinogens and toxicants is substantially reduced.

Implications: To our knowledge, this is the first study that demonstrates that substituting tobacco cigarettes with an e-cigarette may reduce user exposure to numerous toxicants and carcinogens otherwise present in tobacco cigarettes. Data on reduced exposure to harmful constituents that are present in tobacco cigarettes and e-cigarettes can aid in evaluating e-cigarettes as a potential harm reduction device.

1. Maciej L. Goniewicz, PharmD, PhD¹,²,
2. Michal Gawron, PharmD²,
3. Danielle M. Smith, MPH¹,
4. Margaret Peng, BSc³,
5. Peyton Jacob III, PhD³ and
6. Neal L. Benowitz, MD³

+ Author Affiliations

1. 
   
   ¹ Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY;
2. 
   
   ² Department of General and Analytical Chemistry, Medical University of Silesia, Sosnowiec, Poland;
3. 
   
   ³ Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA

1. Corresponding Author: Maciej L. Goniewicz, PharmD, PhD, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carton Streets, Buffalo, NY 14263, USA. Telephone: 716-845-8541; Fax: 716-845-1268; E-mail: maciej.goniewicz@roswellpark.org

• Received March 21, 2016.
• Accepted June 15, 2016.

• © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Health Canada States E-Cigarettes refused to most minors

The majority of convenience stores and vape outlets refused to sell e-cigarettes to young people who tried to buy them during a four-month period last year, a draft report for Health Canada has found.

The study was undertaken to test how easy it was for young people, between 15 and 17, to purchase e-cigarettes with nicotine.

From July to October 2015, teens were sent into more than 4,000 stores across the country to try to purchase e-cigarettes, which heat liquid to create a vapour that often contains nicotine and flavourings.

The teens were sent to convenience stores, gas stations and vape outlets that specialize in e-cigarettes. On average, they were turned away 66.5 per cent of the time.

‘Our government’s plan to legalize and regulate marijuana will also include provisions to limit access. Studies that can show effective means of limiting access of restricted products to youth will be valuable to the task force as they provide our government with expert advice on how the legalization process should take place.’ – Jane Philpott, Canada’s health minister

The numbers were much higher in Prince Edward Island, where teens were refused e-cigarettes 91.5 per cent of the time. New Brunswick, Manitoba, and British Columbia ranked closely behind.

Quebec, where the sale of e-cigarettes to minors is banned, scored the lowest, with stores in Montreal turning teens away just 43.3 per cent of the time.

E-cigarettes with nicotine have not been approved for sale by Health Canada, but are not illegal and are widely available. And while many provinces have passed legislation to regulate them, including prohibiting their sale to minors, some have no rules at all.

Alex Scholten, president of the Canadian Convenience Stores Association, said he would like the numbers to be higher, but says the problem is the patchwork of provincial rules across the country, with no federal regulations.

“I have retailers calling me on a daily basis asking what are the laws? What are my responsibilities?,” Scholten told CBC.

He points to a previous study conducted by Health Canada in 2014 that only looked at convenience stores. It showed minors were turned away 90.2 per cent of the time when asking for e-cigarettes and 84.8 per cent of the time when asking for tobacco products.

Tobacco retailers seeing shift

Scholten said the lack of Health Canada approval means members of his association don’t sell the products — but other other stores do, frustrating convenience store owners who are seeing consumers’ habits change.

“Our retailers have seen tobacco sales go down in recent years with more and more consumers buying vapour cigarettes, or electronic cigarettes. So it has changed how products are being purchased.”

Scholten pointed to the United States, where he said sales of e-cigarettes have doubled every year over a four-year period.

“So with it being a patchwork of regulation at best without federal leadership on this, it’s really a huge void and something that I think is a grave concern to our retail members and but should also be of grave concern to Canadians, because it really is the wild west in terms of a product,” Scholten said.

Health Minister Jane Philpott’s office said on Friday that a final report on this issue will be released by Health Canada in a few weeks.

In the meantime, the minister said in a statement, “Health Canada is actively reviewing health and safety data and scientific studies on vaping products, including e-cigarettes. My department officials and I have had discussions regarding e-cigarette regulations, and I can update you further as we move forward on this file.”

Philpott added that this study, and the limits it found for teenagers, will be used for another government initiative.

“Our government’s plan to legalize and regulate marijuana will also include provisions to limit access,” wrote Philpott. “Studies that can show effective means of limiting access of restricted products to youth will be valuable to the task force as they provide our government with expert advice on how the legalization process should take place.”

Scholten said his members are not lobbying to sell marijuana when it’s expected to become legal in 2017.

He said for now, his association would just like to see the rules for electronic cigarettes applied evenly across the country.

By Susan Lunn, CBC News

E-Cigarettes “much safer than smoking’ experts say

Smokers should be encouraged to use e-cigarettes as a safer alternative, Britain’s Royal College of Physicians says in a sharp departure from other public health advice.

Thursday’s report is based on expert opinion and concludes the hazards to health from inhaling e-cigarette vapours are likely less than the harms from smoking tobacco.

The authors of “Nicotine without smoke: tobacco harm reduction” say people smoke because they are addicted to nicotine but are harmed by the tar and cancer-causing chemicals. It calls smoking the biggest avoidable cause of death and disability and social inequalities in health in the U.K.

Previously in Britain, the evidence base for the safety claim of e-cigarettes has been called an “extraordinarily flimsy foundation” with questions about conflicts of interest.

E-cigarettes heat liquid, often containing nicotine, into vapour. Use of e-cigarettes or vaping is proposed as a lower-risk alternative to smoking .

“E-cigarettes and other non-tobacco nicotine products offer the potential radically to reduce harm from smoking in our society. This is an opportunity that should be managed and taken,” epidemiology Prof. John Britton of the Royal College of Physicians and his co-authors said in a summary of the published in the BMJ.

But the long-term risks of e-cigarette use remain unknown and are likely associated with an increased risk of chronic obstructive pulmonary disease, lung cancer and possibly cardiovascular disease, the authors of the 200-page said.

On the question of how e-cigarettes could lure young people to smoke, the British group said there hasn’t been “demonstrated evidence of significant progression into smoking among young people.”

But in a U.S study of those aged 16 to 26 years suggested use of e-cigarettes was associated with eight times higher odds of taking up traditional cigarette smoking.

The ideal is for people to use nothing. – Linda Bauld

The global market for “vaping” products was estimated at around $7 billion US in 2015.

Tobacco smoking kills half of all smokers, plus at least another 600,000 people a year non-smokers through second-hand smoke.

This makes it the world’s biggest preventable killer, with a predicted death toll of a billion by the end of the century, according to the World Health Organization (WHO).

E-cigarettes with nicotine have not been approved for sale by Health Canada but are readily available.

Many provinces ban sales of electronic cigarettes to minors.

The Canadian Cancer Society says seven provinces, (B.C., Manitoba, Ontario, Quebec, New Brunswick, N.S. and P.E.I.) have adopted legislation to regulate e-cigarettes by banning sales to minors, prohibiting e-cigarette use in public places and workplaces where smoking is banned, restricting advertising and promotion and other measures.

Ontario’s law on sales to minors is in effect and it has proposed a ban on the use of e-cigarettes in enclosed public places and plans to limit where sales are prohibited.

Some municipalities including Vancouver, Edmonton, Calgary and Toronto have also adopted measures to restrict e-cigarette use in public places.

The World Health Organization has also called for bans on indoor use, advertising and sales to minors.

The Canadian Cancer Society holds a similar view.

“This is a product category that needs appropriate regulation, to prevent use by minors, and to prevent industry marketing strategies that would impede smokers from quitting altogether. We support legislation adopted to date by seven provinces that prohibits sales to minors, that prohibits use in places where smoking is banned, and that restricts promotional activities,” Rob Cunningham, senior policy analyst with the Canadian Cancer Society in Ottawa, said in an emailed general comment on the U.K. report.

Dr. Peter Selby, an addictions researcher at the Centre for Addiction and Mental Health in Toronto, wonders why the British team is promoting e-cigarettes when there are proven alternatives, such as quit smoking programs, counselling programs and nicotine replacement patches, inhalers and lozenges.

Other questions remain about the long-term safety of e-cigarettes. For example, e-liquid contains propylene glycol, a common food additive and flavouring. The health risks of inhaling it deep into the lungs is unknown.

Nicotine delivered in ‘cleaner form’

“The ideal is for people to use nothing,” said Linda Bauld, a professor at Stirling University, deputy director of the U.K. Centre for Tobacco and Alcohol Studies and a co-author of the RCP report.  But when the alternative is smoking, people should be encouraged to use nicotine “delivered in a cleaner form than in deadly cigarettes.”

“This is what tobacco harm reduction is — it reduces the harm from tobacco while recognizing that some people will still use nicotine in other safer forms.”

The anti-smoking group ASH UK welcomed the report, saying it showed “that switching to vaping is a positive and sensible life choice” for smokers.

“Electronic cigarette vapour does not contain smoke, which is why vaping is much less harmful,” said Deborah Arnott, ASH’s chief executive.

CBC News

FREDERICTON (GNB) – New Brunswickers are reminded that changes to the Smoke-Free Places Act and to the Tobacco Sales Act come into effect July 1.

“These changes represent our government’s commitment to helping New Brunswickers live longer, healthier lives,” said Health Minister Victor Boudreau. “Discouraging our residents from smoking, especially our youth, will help prevent chronic diseases, lower health-care costs and support a healthier population.”

Effective July 1:

Under the Smoke-Free Places Act smoking and vaping will not be permitted:

• on patios and all similar outdoor public facilities where food and/or alcohol is served and within three metres of the patio’s boundary;

• within nine metres of doorways, windows and air intakes of enclosed public places and indoor workplaces;

• on or within 20 metres of children’s equipment and sports areas located in an outdoor public place;

• on or within nine metres of a public walking or jogging trail in an outdoor public place; and

• within the boundaries of provincial parks except within the boundaries of rented campsites, golf courses and designated areas within the park.

Under the Tobacco Sales Act the following measures will come into effect:

• a ban on the sale of e-cigarettes and their liquids to persons under 19 years of age;

• vapour shops will have age and promotion restrictions;

• the sale of smoking supplies to minors will be prohibited and these supplies will be hidden from sight. This will include rolling papers, blunt wraps, cigarette filters, cigarette holders and pipes; and

• product displays and advertising inside a tobacconist shop or a vapour shop will not be allowed to be visible from the outside, and outside advertisement will be prohibited.

Effective January 1, 2016, flavoured tobacco, including menthol, will not be sold in New Brunswick. Waiting until January gives store owners time to sell flavoured tobacco products they currently have in stock.

The changes will affect restaurant owners and other businesses; municipalities; landlords; government buildings; establishments that sell tobacco products, including e-cigarettes and their liquids; and individuals who smoke or vape.

Operators of businesses and facilities that are frequented by the public and affected by these changes are encouraged to use signage to assist with this transition. The following No Vaping/Smoking Posters are available for download:

• at entrances/exits;

• on patios;

• on sports/activity areas; and

• on playgrounds.

For further information, business owners and facility operators may contact a regional health protection branch office. A list of these offices is available online.

Please Visit our Canadian Electronic Cigarette e-store for all your e-cig needs. We carry a large selection of e-cigarettes, accessories, and e-liquid. If you are new to e-cigarettes, visit our Beginners guide, or read a few Studies completed on electronic cigarettes.

St. Johns Newfoundland school bans vaping at school.

Waterford Valley High in St. John’s says it has zero tolerance for electronic cigarettes, but some students say the new smokes are popular on and off school grounds.

“The [vice] principal … made an announcement that he doesn’t want any vaping in school or around school, or you’ll get suspended right away,” said student Travis Hynes.

“He’s worried about students with allergies and these vapours have lots of scents to them.”

Hynes and friend Vanessa Lewis were both smoking the e-cigarettes as they left school for a lunch break Thursday, and they say a lot of students are interested in them.

“Most people feel that it’s pretty cool. If me or any of my friends have them around, they’re like can I see it … even if they don’t want it themselves,” said Lewis who estimated about a dozen students smoke the vapour cigarettes, compared to at least 40 who smoke tobacco.

Hynes said the e-cigarettes taste better. “You don’t get that gross taste in your mouth afterwards. And you don’t get so congested after you vape. It is a better alternative.”

Store takes stand

There’s no law to prevent minors from buying the vapour cigarettes, but a store near Waterford Valley High has its own policy.

Avalon Vapor decided not to sell to customers under 19.

“A lot of people are speculating that the vaping industry is trying to attract children and we’re definitely not,” said owner Tristan Wall.

“We’re trying to attract smokers and get them away from tobacco because it’s ultimately harming them and we want to offer them something safer. ”

Wall says he doesn’t think the vapour cigarettes should be allowed in schools or most public places.

“It should be treated like a cigarette. I wouldn’t expect people to be walking in the Avalon Mall using the electronic cigarette or at a hockey game at Mile One.”

Newfoundland and Labrador Premier Paul Davis says his government is working on new legislation that will regulate e-cigarettes.

Currently, there are no age restrictions on the purchase of e-cigarettes in the province nor are there any rules governing where they can or can’t be used.

Davis says work has been ongoing to bring forward regulations.

He says the government has been looking at options for legislation looking at what other jurisdictions have done.

Davis says once a review is done, legislation will be tabled in the legislature.

Newfoundland is one of several provinces moving to fill void on e-cigarette regulation while Ottawa still studies the issue.

Come May 31, vapers won’t be able to use electronic cigarettes in indoor public spaces in Nova Scotia.

Nova Scotians under the age of 19 will be barred from purchasing e-cigarettes.

And the same regulations that apply to cigarettes sales–no displays in stores where minors can shop–will also pertain to the cigarette substitutes.

Nova Scotia will become the first province to regulate the burgeoning use of e-cigarettes, but it won’t be alone for long.

British Columbia, Ontario and Quebec are in the process of passing legislation and several other provinces have indicated they plan to as well.

A small but growing list of municipalities has instituted rules limiting e-cigarette use in public spaces (Vancouver) or municipal offices (Toronto). And businesses, especially in the transportation sector, have moved to prohibit use of the devices.

But as e-cigarettes have gone from niche to mainstream, Health Canada–which many people feel should lead the charge to establish Canadian rules–has so far been silent.

Other levels of government have decided they simply cannot delay any longer.

“It would have been, from my perspective, more effective if we’d been able to move forward in a co-ordinated fashion. But we can’t afford to sit and wait for the feds to figure out where they’re going to go,” says Dr. Robert Strang, Nova Scotia’s chief medical officer of health.

With a federal election slated for the fall and Parliament’s summer break mere weeks away, it seems clear the legislation Strang and others are looking for will be a job for the next federal government.

David Hammond, a public health professor at the University of Waterloo in Waterloo, Ont., says e-cigarettes have created a quandary for Health Canada.

“They appear to be frozen,” says Hammond, whose research focuses on tobacco control, harm reduction and, in recent years, e-cigarettes.

“I think they’re absolutely twisted in knots about this. Most regulators are.”

In fact, the products pose a legal and ethical challenge, not only for Health Canada but all involved in the public health movement that has, over decades, succeeded in driving down smoking rates by limiting how cigarettes can be packaged and sold and where they can be smoked.

Some anti-tobacco advocates want e-cigarettes to be treated exactly like cigarettes. They argue the devices perpetuate nicotine addiction, may entice teens to take up smoking, and could undermine the hard-fought smoking bans.

“Smoke-free places are a great motivator for people to quit. And if you were to undermine that, then you undermine the benefits of one of the key tobacco control strategies,” says Rob Cunningham, a senior policy analyst for the Canadian Cancer Society.

But other anti-tobacco proponents see the devices as an opportunity to get hardcore smokers to stop consuming nicotine in a way that endangers their health and the health of those around them.

“I’m very big on the idea of alternative nicotine and I see electronic cigarettes … as an indication of where we could go,” says David Sweanor, a University of Ottawa law professor who has worked for years in tobacco control.

The potential promise and perceived perils of e-cigarettes have driven a huge wedge through the anti-tobacco community.

“There are bitter divides in terms of people’s opinions,” says Hammond.

“They still share the same goal. It’s actually just that people think that these products are going to push the needle in different directions.”

The legal status quo in Canada is this: e-cigarettes that are sold with e-juice containing nicotine, or which make health claims, fall under the Food and Drug Act, Health Canada says. That law requires Health Canada’s approval to import, advertise or sell these products. And to date, Health Canada has not approved a single e-cigarette.

So in theory it should be impossible to buy e-cigarettes with nicotine-containing e-juice in Canada. There’s a lot of daylight between theory and reality, however.

“You can (find them) down any Main Street,” says Hammond. “I’ve got one (store) about 100 metres from my office. They’re selling nicotine containing e-juice.”

Health Canada may be working on new rules for e-cigarettes. (The Canadian Press asked the department for an interview on the issue, but received written answers to questions instead.)

Last fall, Health Minister Rona Ambrose asked the health committee of the House of Commons to study e-cigarettes.

The committee’s report, written after a series of consultations, was issued March 10. It recommends the federal government establish a new legal framework for e-cigarettes, sold with or without nicotine e-juice.

It recommends banning sales to minors, prohibiting use in federally regulated public places, restricting advertising of the products, barring the sale of e-juice flavours–such as candy flavourings–aimed at the youth market, and establishing limits on how much nicotine e-juice can contain.

“This parliamentary report, I think for the first time, will require them to be explicit, not just about their current position but potentially where they might go. And that, I think, would benefit everybody,” Hammond says.

Under Parliamentary rules, Health Canada must respond to the report within 120 days, which means by July 8. If Parliament has already broken for the summer, the response must still be tabled in July.

But as one old parliamentary hand notes, some government responses to reports are more detailed than others. With the legislative stasis that accompanies the run up to elections, Health Canada may not feel compelled to tip its hand at this point.

Strang insists he remains hopeful the federal government will make its position clear.

“From my perspective, we need to be acknowledging the risks and benefits of these products and creating some appropriate regulatory environments. And the sooner we do that, the better.”

By Helen Branswell/Canadian Press

Prince Edward Island first reading completed on vaping ban

Prince Edward Island vaping ban has first reading September 9th, 2015.

They are making an amendment to two of their current bills, bill 9 – the smoke free places act and bill 10, the tobacco sales and access act, that will now include vaping.

Currently these amendments have passed their first reading.

The amendment to bill #9:

This amendment would simply add e-cigarettes to the current smoking/cigarette regulations, making it illegal to vape anywhere smoking is prohibited.  They include “electronic smoking device” with their description of smoke free places act, as well as define ‘second hand smoke’ to include a mixture of the gasses, particles or vapours by: an ignited tobacco product, or an operating electronic smoking device, water-pipe, or other device or instrument used or intended to be used to deliver vapour or smoke by inhalation from the device in a manner that resembles smoking tobacco. AND exhaled by a person who has inhaled gases, particles or vapours from a product, device or instrument.  Phew!

In basic terms, this amendment will essentially classify all vape products as tobacco products, and all currently held tobacco laws towards tobacco products in Prince Edward Island will now cover e-cigarettes.  The original smoke-free places act is available to view here.

The Amendment to bill #10:

This amendment will add the words “and electronic smoking device” after the words ‘tobacco’ in the title.   It will also add this definition:  “electronic smoking device” means an electronic or battery operated device used or intended to be used to deliver vaporized solutions by inhalation from the device in a manner that resembles smoking tobacco, such as an electronic cigarette,  electronic cigar, electronic cigarillo, electronic pipe or electronic waterpipe, and includes a cartridge, solution or replaceable component used or intended to be used in such a device.  It will also add the term ‘water-pipe’ after the word ‘pipe’, adds the word “or an electronic smoking device” after the words “sale of tobacco” and finally defines ‘waterpipe’ as the following:  “waterpipe” means an instrument used or intended to be used to smoke tobacco or other products, in which smoke generated during its operation passes through a liquid before it may be inhaled
from the instrument.

In basic terms, this will result in all tobacco restrictions in the tobacco sales and access act to include e-cigarettes and waterpipes.  This will mean that all restrictions, including advertising, display, and testing for e-cigarettes will be as limiting and as heavily fined as with tobacco products.   You can view the original tobacco sales and access act here.

What this means for vapors in the province of Prince Edward Island:

This will be a major blow to the vaping industry in Prince Edward Island.  It will result in restrictions including:

• No sales to minors (which is a good thing)
• No testing or use of e-cigarettes/vapes inside of a vape shop
• No flavouring of any kind in e-liquid
• No advertising (including inside of store) of any products or services
• No display of products in store
• No assistance with vape gear in store

This amendment will essentially both cripple a vape shops’ ability to exist – How can you operate a vape shop without any advertising or the ability to display or advertise your new products?, and also ‘demonize’ vapes to those currently smoking, making them appear just as negative and dangerous/harmful as tobacco cigarettes.  This will potentially cause thousands of smokers in Prince Edward Island to not have the opportunity to choose a safer alternative to smoking cigarettes, which will be deadly to many.

The now infamous bill 90, the first e-cigarette related provincial bill to be affected in Canada was ultimately amended to reduce the potential issues for vape shops in Nova Scotia.

The main aim of bill 90 was against tobacco, and ultimately they had a number of acts toward flavoured tobacco, effectively banning its sale.  They had snuck in a caveat adding e-cigarettes to tobacco cigarettes, and attempted initially to place them both in the same light.

Fortunately due to the protest of vapors and vaping advocates in Nova Scotia, several amendments were added to the final bill which assisted in reducing the difficutlies vape shops woudl have if the bill passed as originally written.  They amended e-juice/e-liquid out of the restrictions, so that vape shops could continue to sell falvoursd e-liquid.  The second ammendment was to allow vape shops to continue to sell and display e-cigarettes, as long as they restrict customers to 19+.

Here is a list of the amendments made to the bill:

The following changes made to tobacco legislation last fall will also be effective May 31, 2015:

Under the Smoke-free Places Act, e-cigarettes and waterpipes will not be used in indoor public places or workplaces in Nova Scotia.

Under the Tobacco Access Act, vendors will have to treat e-cigarettes the same as regular cigarettes:

• keep them out of view, unless the store sells only e-cigarettes and minors are not permitted entry
• no point-of-sale promotion
• no signage or advertising outside the store
• no selling to minors (youth under 19)
• no selling in pharmacies and other places where tobacco sales are prohibited

Adult Nova Scotians (19 and older) will continue to have access to e-cigarettes from most current vendors.

While e-cigarettes are being treated like regular cigarettes in retail settings, they will not be taxed as a tobacco product.