.png?width=69&height=53&name=Acrisure%20Logo%20(White%20Horizontal).png "Acrisure")
JULIE LILLEGREN
Communications Specialist at HNI
With the emergence of e-cigarettes on the market, people have flocked to the smokeless cigarettes with the intention being a "lesser of two evils" alternative for either themselves or loved ones.
But employers beware: studies are emerging that should not only make consumers rethink vapor cigarettes, but HR professionals rethink their benefits and wellness incentives with e-cigarettes in mind.
The Facts on this Growing Trend
Smoking has been put in the spotlight for countless health risks. Most states now ban smoking 
inside and around public buildings -- yet vaping-associated risks have yet to be addressed.
While cigarette sales have been declining, e-cigarette sales are expected to climb upwards of 24% per year.
So why are consumers latching on to e-cigarettes with all the reports exposing the harmful effects of smoking? A lack of health investigations surrounding e-cigarettes along with manufacturers' marketing efforts have contributed towards a skewed consumer product perception.
The slim, reusable and customizable designs of e-cigarettes are not banned in public and there is no overpowering, lingering smell from use like their smoking counterparts. They don't even have an excise tax on them.
Enticing flavors are now on the market including banana pudding, cherry bomb, pina colada, and mocha mist in an effort to enhance user experience with the product. Some e-cigarette tubes even have LED lighting that can change colors as they are being used.
The Reality: Employee Health Risks
Unbeknownst to many, these commonly perceived "safe" vapor e-cigarettes (which often times are viewed as a healthier smoking alternative) come laced with their own health risks. They are linked to asthma, stroke, diabetes, and heart disease, not unlike their traditional smoke counterparts.
The vapor also contains a cocktail of scary stuff like masked formaldehyde and lung-irritating aerosol solvents which break down into carbonyls once heated [a.k.a. cancer-causing chemicals and carcinogens, for those of us whose memory of chemistry class is but a blur.]
First-generation e-cigs didn't deliver that strong hit of nicotine that regular cigarettes did, so second-generation e-cigs have been engineered to increase in temperature to crank out more nicotine - and carbonyls.
Flavors used in e-cigarettes add to the growing list of associated health concerns; depending on what e-cigarette flavor a person chooses, certain toxin levels and disturbances are introduced to the lungs, including tissue cell alteration and stunted growth.
Secondhand Vaping Exposure
While there is not secondhand smoke with e-cigarettes, there is instead secondhand aerosol that people around an e-cigarette smoker are exposed to.
Secondhand aerosol [which the e-cigarette manufacturers market as "vapor"] contain nicotine, ultrafine particles and low levels of toxins, many of which are carcinogenic. Children who are around an e-cigarette user long enough to surpass the short-term effects of eye, throat and airway irritation can also develop asthma due to long-term inhalation exposure.
E-cigarette vapors can also make dangerous germs, such as MRSA, even more difficult to kill by inhibiting the body's natural antibiotics and have been documented to repress coughing which in turn represses the body's natural response to potential infections or choking hazards.
Even if people are not around an e-cigarette user while they are using, there is a risk of thirdhand exposure to nicotine that has accumulated on indoor surfaces. The aerosol in e-cigarettes are also doing a number to the environment as a new source of pollution and toxins to the air.
How this Impacts Wellness Program Incentives
Educating employees and providing cessation resources can help employers take a step towards reducing and [hopefully] eliminating employee e-cigarette use along with traditional tobacco products.
It may be premature to incorporate e-cigarette usage in a wellness incentive program as there is still a great deal of complexity surrounding it. The FDA has not yet proposed any guidance for these unregulated products.
If you build an incentive for abstaining from e-cigarettes into your wellness program, implementing cotinine [a metabolite of nicotine] testing can help validate a participant's tobacco-use status because it tests for nicotine, which is found in both cigarettes and e-cigarettes.
Like all tobacco products, small amounts may not be detectable or be considered similar to second-hand smoke. Most labs have a defined level when the nicotine level is high enough for the person to be considered positive. If the lab deems a person to be positive of tobacco use, they "lose out" on the incentive unless they complete a reasonable alternative standard.
A great time to educate participants on e-cigarettes is through employee health assessments, where tobacco use risks and facts can be clearly addressed to discourage the use of the product.
Kicking the E-Habit
E-cigarettes are not proven methods to aid in quitting smoking - in fact, they reduce the likelihood that people will quit smoking. Once employees are aware of the health risks associated with electronic cigarettes, the next step from a benefits perspective is to provide resources to quit.
By law, ACA compliant health plans are required to cover FDA-approved smoking cessation products and counseling, at no cost to their members.
The FDA does not recognize e-cigarettes as a smoking cessation product. Moreover, the FDA does not currently regulate e-cigarettes at all, but has proposed expanding its authority to include tobacco products such as e-cigarettes as an FDA regulated tobacco product.
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