Electronic inhalers (EI’s) are devices that are gaining enormous popularity in the US and the world. The units go by a number of different names:

  • electronic cigarettes (or e-cigarettes)
  • electronic vaping devices
  • personal vaporizers (PV)
  • electronic nicotine delivery systems (ENDS)

These devices use a liquid solution (juice) which is heated to vaporize and then inhaled. Some of the liquids contain nicotine, while some merely release flavored vapor.  Nicotine levels in the liquids vary between preparations.  Tobacco is not used in e-cigarettes, though tobacco companies are investing heavily in EI’s.

E-cigarettes are often designed to mimic traditional smoking implements, such as cigarettes or pipes, in their use and/or appearance, although more and more devices are designed not to imitate them, in an attempt to develop a different culture of user.

In a recent edition of the Medical Letter® (Volume 54, Issue 1404), an analysis of e-cigarettes from 2 different brands done by the FDA found a number of impurities, including polycyclic aromatic hydrocarbons, which are carcinogenic, and other potential carcinogens.

Potential Implications for Wellness Incentive Programs:

Tobacco-free incentive programs:  EI’s do not use tobacco.   Programs focusing only on “tobacco use” (including, but not limited to, cigarettes, pipes, cigars, and/or chewing tobacco), would not have to include e-cigarettes in their definition.

Nicotine-free incentive programs: Many of our clients test for nicotine and its metabolite, cotinine, rather than relying on an affidavit. Thresholds assigned for these tests correspond to routine tobacco use. Studies we reviewed indicate that the nicotine levels produced by EI’s are not sufficient to register as positive on traditional blood or urine testing. All studies indicate circulating nicotine levels are much lower with EI use, thank with traditional tobacco use. Nicotine absorption through EI use occurs in the mouth area, rather than the lungs, as occurs with cigarette use.

Inhalant-free incentive programs: In 2013 Be Well began offering an e-cigarette inclusion in their traditional tobacco affidavit. At this point few clients have chosen to include EI language. We believe this will increase in the upcoming years.

BWS Position on Electronic Inhalant Systems:

No one should consider inhalant systems safe, or without potential long term risk.  Many contain nicotine and also contain chemicals which are potentially harmful and carcinogenic.

Definitive evidence regarding the dangers of EI’s will not be available for several years, even decades. Be reminded, that in the beginning of the 20th century, cigarettes were felt to be without substantial risk, and lung cancer was very rare. By the middle of the 20th century, lung cancer became the leading cause of cancer death in our country (a position it continues to hold today), and cigarette smoking continues to be a major health hazard.

Preliminary research, often funded or performed by the EI industry, suggests that EI’s may be a useful adjunct during tobacco cessation, and represent a “safer alternative” to traditional tobacco use. We believe that this evidence is preliminary and has not been substantiated by scientific testing to this point.

Be Well supports companies who choose to reward employees/spouses for totally inhalant free lifestyles (tobacco and/or vapor) and are pleased to include such language in affidavits.   We believe this approach is most consistent with the objective of promoting healthy lifestyles. Examples of such waivers are available upon request.

We will continue to accommodate our clients who wish to retain their traditional approach to rewarding tobacco-free or nicotine free lifestyles as well.

In addition, we will be adding a question on EI use to our 2014 Health Risk Assessment.