A reader of last week’s blog post on vaping asked us if employers should actively promote e-cigarettes in their wellness programs as a smoking cessation tool. This is an excellent question. It’s admittedly tough to ascertain if e-cigarettes are going to be the next major health hazard or the most effective smoking cessation technique ever created. Unfortunately, there’s not a straightforward answer to this question, but we will attempt to answer it as best we can.
What is Vaping?
For the uninitiated, vaping is the act of inhaling atomized liquid, usually nicotine dissolved in propylene glycol plus flavoring and colors. The device used for this activity is called an e-cigarette; a battery-operated device, often shaped like a cigarette, which is designed to deliver nicotine in the form of an inhalable vapor rather than tobacco smoke.
E-cigarettes are sometimes called “e-cigs” or “vape pens”, and users are commonly referred to as “vapers”. No longer a niche or novelty product, the e-cigarette category generated $1.5 billion in sales in 2014, and is projected to grow at 20% year-over-year going forward.
Vaping To Break The Habit
Nearly 40 million people in the U.S. smoke, representing 16.8 percent of adults aged 18 years or older. Of this group, the CDC estimates that 68.9 percent want to stop smoking, while 42.7% actually made an attempt to quit in the past year.
While nicotine patches and gum are two of the most popular smoking cessation techniques, their efficacy is sometimes called into question. And no matter, one would think that having another cessation technique in the tool chest should be a welcome addition to the seven therapies already approved by the U.S. Food and Drug Administration.
Many smokers trying to break the habit use e-cigarettes as a smoking cessation tool. But let’s be real: smokers who have no intention of quitting whatsoever also use vape pens, mostly as a way to get their nicotine fix indoors. (There is also some evidence that e-cigarettes have even brought some former smokers back into the fold.
Are E-Cigarettes An Effective Cessation Device? Do They Help Smokers Quit?
Since vaping so closely resembles the act of traditional smoking, the transition to a smoke-free lifestyle is considered by many to be easier and more natural than other cessation tools like nicotine gum and nicotine patches. That said, the act of vaping in public spaces is quickly becoming as ostracizing as smoking traditional tobacco products in these same places.
E-cigarette proponents argue that vaping, much like nicotine gum and patches, can help smokers slowly wean off of traditional, tobacco-containing cigarettes by gradually allowing the user to reduce the amount of nicotine they use over time. Most users getting away from cigarettes start off on 24 mg nicotine strength, and eventually, but not always, work there way down to 12 mg, and then down to 6 mg.
Anecdotally, vapers claim to enjoy a better night’s sleep, don’t snore as much, and experience an improved sense of taste as well as improved energy.
More important that anecdotal evidence, however, are scientific studies. And in that regard, according to a study led by Boston University School of Public Health, e-cigarette usage is twice as effective as traditional nicotine replacement products in promoting smoking cessation.
So why then aren’t e-cigarettes officially categorized as Nicotine Replacement Therapy (NRT)? The answer lies in the fear of the unknown.
Are e-Cigarettes Safe?
Much is known about what substances in cigarettes do the most harm. “According to the American Cancer Society, the smoke produced by burning dried tobacco leaves and other additives contains a complex mixture of more than 7,000 chemicals, including more than 70 known to cause cancer and, in some cases, heart and lung disease,” says Michael Blanding, editor of Harvard Public Health. “Among these deadly substances are cyanide, benzene, formaldehyde, methanol, tar, and poisonous gases such as carbon monoxide.”
Michael continues, “Unfortunately, we know far less about exactly how dangerous nicotine—the addictive and psychoactive substance in cigarettes and e-cigs—is. Surprisingly, few large-scale studies have examined nicotine addiction separate from cigarette smoking. Some studies on nicotine replacement therapy (such as patches and gum) during pregnancy have found adverse effects on fetal development and an increase in preterm labor, though at rates lower than those linked to cigarettes.”
Of course beyond nicotine are all of the other byproducts in e-cigarettes. The main component of e-cigarettes is the liquid contained in their cartridges. To create this liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol) and other substances including flavorings, colorings and other miscellaneous chemicals.
Because no government oversight exists for these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market, all without an FDA evaluation determining precisely what’s in them. At present, the FDA simply requires e-cigarette makers to register with the agency, self-report ingredients, submit new products for review, and provide evidence regarding any health risks and benefits of the products.
While it’s believed to be true that tobacco leaf, tar and the other 70 carcinogenic chemicals found in cigarettes are absent from e-cigarettes, there are other potentially harmful substances in vaping liquid that could pose a health threat to vapers and those around them exposed to secondhand emissions.
In 2009, the FDA found detectable levels of toxic cancer-causing chemicals, including an ingredient used in antifreeze, in two leading brands of e-cigarettes and 18 various cartridges. A review of these studies found that levels of toxins in e-cigarette aerosol varied considerably within and between brands.
The American Lung Association also points to the flavor additives in e-cigarettes as a cause for concern, citing not only their appeal to kids, but also their potential to harm one’s health. According to the ALA, “E-cigarette and flavor manufacturers suggest that the flavor ingredients used in e-cigarettes are safe because they have FEMA GRAS™ status for use in food, but such statements are false and misleading. The reality is that FEMA GRAS™ status does not apply to inhaled substances; it only applies to food, meaning that substances with FEMA GRAS™ status are safe to eat, but perhaps not to inhale.”
Finally, just last month, researchers at the University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System reported data suggesting that e-cigarettes are toxic to human airway cells, suppress immune defenses and alter inflammation, while at the same time boosting bacterial virulence. Their study was published January 25 by the Journal of Molecular Medicine.
The Lesser of Two Evils?
Despite all of these findings, a study published in the Journal of Public Health Policy found that e-cigarettes contain up to 1,000 times less carcinogenic chemicals than traditional cigarettes. And a report last summer, commissioned by Public Health England (PHE), found electronic cigarettes to be 95% less harmful than smoking tobacco.
And beyond these study, and others like them, the general consensus in the medical community is that the health hazards of continuing to smoke are much worse than the potential risks associated with nicotine replacement systems.
Net, although not perfect by any means, e-cigarettes may be a less dangerous alternative to traditional cigarettes and can be an effective tool to help smokers quit for good. Nevertheless, as we mentioned in our other post on vaping last week, e-cigs are not considered by most insurance carriers to be any different from cigarettes and other tobacco products. This means that vapers will, in all likelihood, be considered “smokers” while they use these devices.
Looking Ahead - How Can These Safety Issues Be Settled Once & For All?
It’s clear that extensive research from objective sources is required to clear the air. Harvard Public Health’s special report The E-Cig Quandary, sums it up best: “Public health investigators would like to see studies that clarify how and under what circumstances people are using e-cigarettes; long-term studies of health effects; clinical trials that show how effective e-cigarettes are compared with conventional cessation approaches in helping people quit smoking; and targeted laboratory studies that analyze the harmful constituents of e-cigarettes.”
Until such time, however, smokers trying to quit and insurers and employers who want to help will be left wondering.
Contact us for more information about this topic and others which will help you better assess risk while you chart a course towards wellness programs which will help your employees live healthier lives.
Editor's Note: Since publishing this blog post, the FDA, on May 5, 2016, announced that it was assuming regulatory authority over e-cigarettes. The tough set of rules announced that day will be phased-in over a three-year period.