E-Cigarettes: What Are The Health Risks And How Do Insurers See Them?

From nicotine patches to support groups, self-help books to seminars, smokers will try anything to quit smoking, which is an addictive habit. But what about e-cigarettes? How do they work and what are the short- and long-term health effects?

E-cigarettes generally use a heating element known as an atomiser, which vaporises a liquid solution. They have the look and feel of a cigarette and they even emit a vapour, similar to the smoke of a normal cigarette. But are e-cigarettes a health risk?

The growth in the use of e-cigarettes has been exponential, with sales growing 30% a year in the past three years globally*. In South Africa they are also becoming increasingly popular with many people who see them as a healthier alternative to traditional cigarettes.

From an insurance point of view there has been some controversy around the health effects of e-cigarettes and how they are regulated. Should they be considered a tobacco product or a drug delivery device? Health advocates want them classified the same as regular cigarettes because they contain nicotine (an addictive substance), but many e-cigarette users and manufacturers want them classified as smoking cessation devices, ie non-tobacco products. In the USA it seems likely that the Food and Drug Administration agency will re-affirm that e-cigarettes should be regulated as a tobacco product.

There are several things that we need to consider at Nedbank Insurance:

1. E-cigarettes do not contain tobacco but are typically used to deliver refined nicotine to users in a polyethylene glycol water mist (like with a medicinal inhaler), meaning that there are no inherent tobacco-associated risks. But when it comes to routine cotinine screening, we can’t distinguish an e-cigarette user from a tobacco smoker, so we would have to classify you as the latter.
2. The use of e-cigarettes as a way of quitting tobacco use(compared with other more established nicotine-containing smoking cessation products) is being met with cynicism in some clinical quarters.
   
3. The fact that consumers can modify the nicotine dose being administered when the reusable canisters are refilled is worrying, as excess nicotine itself is known to have adverse health consequences. This raises the possibility of e-cigarettes carrying a health risk.
   
4. The risk of long-term exposure to or inhalation of a mixture of polyethylene glycol, nicotine and water vapour has not yet been established.
   

In keeping with Nedbank Insurance’s underwriting approach smoker rates will apply to all of our clients who:

• smoke (including the use of e-cigarettes);
  
• have stopped smoking within 12 months before applying for cover with us; or
  
• present a positive cotinine test when they apply.
  

We know you probably don’t need to be told this, but smoking is damaging to your health and can impact many other things, such as your life insurance premiums. Quitting once and for all is the best solution.

* Renaissance Capital report August 2013.