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Although American Spirit markets its products as "natural" and "additive-free," studies reveal that they contain comparable or even higher levels of harmful chemicals, including nicotine, than other brands

But those flavour restrictions differ across the country, creating a patchwork of protections and making enforcement especially difficult for provinces and territories with comprehensive restrictions

CONFLICTS OF INTEREST The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest