The CDC indicates that smoking causes nearly one in five deaths every year in the United States and that cigarette smoking is the leading preventable cause of death. While everyone knows that “tobacco = bad for you,” there continues to be a surge in smoking popularity due to the use of non-traditional tobacco products such as the nicotine or herb-based liquids for “vaping” and the use of e-cigarettes (e-cigs).

So, what exactly is vaping? Vaping is defined as the act of inhaling the vapor produced by heating a propylene glycol or vegetable glycerin-based liquid, mixed with small amounts of nicotine and flavoring, through a battery-powered atomizer (“vape pen”) which produces no smoke and only vapor. The vapor is inhaled, similar to how one would inhale a cigarette.

In 2018, vaping increased by 78 percent for high school students.

Vaping has become a personal experience for the user, just like ordering a latte is. Some like it tall and skinny and others like a touch of whip cream and a dash of nutmeg. This custom experience enhances the appeal. Start with vape pens. Users choose from standard pens to statement pens with superhero logos or that are wildly colored and bedazzled. These pens are designed for the user to feel unique and show their personality. Next, the user chooses from an extensive variety of flavored vaping liquids. The liquids come in classic flavors such as cinnamon or cherry to custom flavors with unique names, such as Mothers Milk and Dewberry Cream. Similar to wine or other spirits, these flavors come with descriptive and appealing tasting notes such as “A perfect balance of fruits and cream that starts with a subtle sweet honeydew, followed by mixed berries.”

Vaping has moved beyond an experience. It has evolved into a culture with a “shared-interest” community with vape shops and lounges, YouTube videos, blogs and magazines, and yes, even VapeCon. Younger generations in particular view vaping as cool and fashionable. According to the FDA, there were 3.62 million middle-school and high-school student users in 2018. This was an alarming and substantial increase over 2017, increasing by 48 percent for middle school students and 78 percent for high school students.

Science News for Students outlined the perception that vaping is a better option than smoking a cigarette because the products do not contain tobacco. While it’s true, vaping liquid does not contain tobacco; it typically contains nicotine and, therefore, is considered a tobacco product. In 2016, the FDA extended regulatory authority over all tobacco products including numerous variations of vape pens. In 2018, the FDA began requiring a warning statement on all newly regulated tobacco products that indicate the product contains nicotine, an addictive chemical.

To complicate the matter for employers, in a 2014 e-cigarette policy released by the American Heart Association, the association pointed out that vaping was modestly effective at helping smokers quit, equal to or slightly better than nicotine patches without behavioral support, but that it should not be the primary cessation aid. While it can potentially be a tool for cessation, it is important for employers to remember that the FDA has not approved it for that purpose. Although there are limited studies on the health hazards that come with vaping, it is known that the liquid used to create the vapor contains numerous harmful chemicals such as formaldehyde and acetaldehyde, both carcinogens. It also contains toxic metals including nickel, chromium, and manganese. In addition to potentially causing cancer, manganese negatively impacts the nervous system. Supplement these chemicals with the latest trend in vaping, “dripping,” where the e-liquid is manually dripped directly on the vaping tool’s heat coil enabling it to reach a hotter temperature for a more intense and concentrated vapor cloud. The concentrated vapor cloud, and its increased toxicity, is inhaled deeply into the lungs. This deep inhaling could be why one study showed vape users commonly experience a “smokers cough” or technically speaking, chronic bronchitis.

The FDA released regulations meant to tighten restrictions on e-cig marketing. In March of 2018, the FDA delayed these new regulations and extended the compliance window until 2022. Due to the concerning nature of these delays, several industry groups including the American Cancer Society, American Lung Association, American Heart Association, and American Academy of Pediatrics filed suit against the FDA. The FDA is opening up conversations on restrictions again, particularly in response to the extreme increase in youth consumption.

Alliant is continuing to monitor updates to regulations for our clients and assess the impact to employer-sponsored programs.

There has been significant news coverage on incidents of vaping cartridge explosions that cause severe injuries. One man’s injuries were so severe, he landed in intensive care with second degree burns to his face and neck, seven teeth destroyed, and pieces of his teeth and vaping pen embedded throughout his mouth, throat, and lips. Damaged lithium-ion batteries used in the vaping pen to heat the cartridge and release the vapor are believed to have caused the combustion. Another man wasn't as lucky when his cartridge exploded. It pierced an artery and killed him. How does a user know when their vape pen batteries have been damaged? Do users regularly check for damage? Information on how to protect and maintain a vape pen is available, but like anything else, maintenance is a personal responsibility.

So, how can employers address vaping in their health and wellness policies?

First, confirm you are addressing vaping as a part of your worksite policies. Review your policies regularly, but particularly as regulations change or are established.

Be diligent with your efforts to promote overall health and wellness. While reminders to employees about the cessation resources covered under your medical and pharmacy benefits are great, be sure to address vaping in the health and wellness communications that you release to employees. Find a way to get these health messages to employees' spouses and dependents. This is essential given the significant increase in youth consumption.

If you need new ideas to address critical, rising issues such as vaping; ask your Alliant representative. We're here to help you.