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"This was done to try to keep insurance affordable for as many people as possible." The federal exchange, which includes 26 states, will be using the tobacco penalty, said Linda Blumberg, who focuses on health insurance research at the Urban Institute, though eight states have decided not to use it

Cigarette smoke exposure impairs epithelial respiratory ciliogenesis

With this major shift, all of the main players barring Japan Tobacco, which is only just embarking on the journey, are earning money from smokeless products

Approval is rare

The use of e-cigarettes is banned in enclosed public spaces in several US states, including California and New York