E-Cigarettes: A Hazard or a Help?

A global debate has arisen regarding the relative benefits and harm resulting from the use of electronic cigarettes (“e-cigarettes”). In some countries, such as the United Kingdom, the use of e-cigarettes (“vaping”) has been shown to help reduce addiction to combustible tobacco cigarette (“smoking”), which represents the leading preventable health hazard in many countries. In contrast, in other countries, such as the United States, e-cigarettes, which have attracted many adolescents and young adults who would not otherwise have started to smoke, represent an alternative delivery vehicle for nicotine or cannabis (marijuana) by expanding their markets, reducing nicotine cessation rates by means of a more convenient, healthier, and less offensive product. Although considered less harmful health-wise than smoking, the expected net effect of vaping remains controversial, as sufficient experience has not yet been accumulated to confirm the health impacts, especially over the long term. Nevertheless, viewed by themselves, e-cigarettes do represent a health hazard, with growing information regarding their adverse effects. The stakes of this debate are high—for individuals, society and the e-cigarette, tobacco, insurance, and health care industries. After highlighting the current use of e-cigarettes by adults and adolescents, this article summarizes current issues associated with e-cigarettes, highlighting their health effects; nicotine and addiction; initiation; smoking cessation and harm reduction; gateway to smoking; modifications; flavorings; secondhand aerosol; and new product innovations. It discusses the sources of disagreements and reactions from regulators and life insurers. In addition, the modeling, estimates, and uncertainties associated with mortality resulting from vaping are addressed. For life and health insurance, actuaries are assessing whether to treat e-cigarette users in a manner similar to those who smoke combustible tobacco cigarettes.