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If consumers are not able to access or afford these reduced-risk alternatives to cigarettes, they will be forced to turn back to combustible tobacco, which is far more dangerous and will have life-long consequences on their health. And because many vape manufacturers are mom-and-pop shops, the letter writers argue, they do not have access to the alternative large-scale distribution networks which the tobacco industry uses to provide combustible cigarettes to retailers

[5] [6] She holds dual citizenship of Canada and the United States

For an example of a Health Equity Impact Assessment for Tobacco 21, see Multnomah County, Oregons example