The Well-Being Journal

E-Cigarettes: The Next Best Thing in Smoke-Free Environments?

Sandy Cummings

By Ann Wendling, MD, MPH
Medical Director, Tobacco Cessation, Healthways

In just a few years, e-cigarettes have advanced from difficult-to-find novelty to readily available commodity widely marketed as a healthier alternative to cigarettes. But with research and regulatory action struggling to keep pace, what do we really know about e-cigarettes?

Food for thought

E-cigarettes, whether manufactured in China or the United States, are not subject to production and content regulation, leading to a multitude of products with inconsistent nicotine delivery and complicating any research on safety and effectiveness.

Usage is increasing dramatically among both youth and adults – about 7% for both in 2012. Alarmingly, a Legacy for Health February 2014 survey found current e-cigarette use at 9% for ages 13-17 and 29% for ages 18-21. Dual use with conventional cigarettes predominates.

Limited population studies and clinical trails have not shown quit efficacy or effectiveness. However, recent data from a survey of almost 6,000 recently quit smokers in England, published on May 21, suggested a promising real-world effectiveness of 1.6 times for e-cigarettes compared to over-the-counter nicotine replacement therapy (NRT) and 1.4 times compared to unaided cessation.

Safety studies have had variable results:

  • We know ultrafine particles, dependent on the presence of nicotine, are small enough to reach deep into the lungs and subsequently the systemic circulation.
  • Cytotoxicity is variable among products and can be related to the concentration and number of flavorings.
  • Exposure to e-cigarette aerosol, often containing glycerin or propylene glycol, can cause throat and mouth irritation, cough, nausea, vomiting and increased airway resistance. No long-term safety data have yet been collected.
  • Secondhand exposure to nicotine as well as other toxins in the vapor has been detected in several studies, albeit usually at lower concentrations than secondhand smoke.

The public health effect

If indeed smoking cessation were as simple as switching from conventional cigarettes to e-cigarettes, undoubtedly there would be significant benefit to the public’s health. But it is not this simple.

Up to a third of youth have only used e-cigarettes. Will this set them on a trajectory toward a lifelong addiction to nicotine and eventually conventional cigarettes?

In addition, most adults are dual users – are they using e-cigarettes to vape in smoke-free environments or to cut down on more costly conventional cigarettes, believing they are at less risk for smoking-related disease? Data do not necessarily support the latter premise. If e-cigarettes delay total abstinence, the health burden may actually increase.

Until clean indoor air policies universally include bans on e-cigarette use (only three states have them to date), there is increasing risk for social acceptance/normalization of smoking/vaping behavior. Fortunately, more states are on board with limiting sales to minors.

What's on the horizon?

If we follow the same course as the past couple years, we can expect continuing exponential growth in e-cigarette consumption. Fortunately, on April 24, 2014, the U.S. Food and Drug Administration (FDA) took the first step toward regulation by proposing a Deeming Regulation to assert jurisdiction over other tobacco products, including e-cigarettes. Unfortunately, the regulation does not include limits on marketing/advertising and flavor additives attractive to youth and will take up to several years for some of the regulations to take effect.

The Patient Protection and Affordable Care Act, according to recently released guidance, requires most health plans to cover FDA-approved smoking cessation products and counseling without any out-of-pocket cost to consumers. E-cigarettes, not proven or approved as cessation tools, will not be covered. This may not be a significant barrier to the escalating use unless more states tax e-cigarettes at a level comparable to conventional cigarettes.

Many questions remain unanswered. How will e-cigarettes be viewed by health plans and employers? Will vapers be considered tobacco users and pay higher healthcare premiums?

The next several years will yield much needed data on the safety and efficacy of e-cigarettes while we observe a natural experiment of "free-range" marketing, easy access and escalating use and wait for guidance and regulation. Until then, the evidence supports a combination of behavioral therapy and FDA-approved cessation aides to assist tobacco users in quitting.

References

Grana R, Benowitz N, and Glantz SA. "E-Cigarettes: A Scientific Review." Circulation 129:1972-1986, 2014.

Brown J, Beard E, Kotz D, Michie S and West R. "Real-world effectiveness of e-cigarettes when used to aid smoking cessation: A cross-sectional population study." Addiction 109: doi: 10.1111/add.12623, 2014.

Legacy for Health. "Vaporized: E-Cigarettes, Advertising, and Youth." Report. May 2014.

Andrews M. "E-Cigarette Users May End Up Paying More For Insurance." Kaiser Health News. May 20, 2014.

Topics: Healthy Living Well-Being Links of the Week In the News Smoking Cessation Health E-Cigarettes

Five Hits of Community Well-Being for June

Sandy Cummings

The weather's looking good, and it's time to get out and enjoy it. Here's a quick list of community events to help improve your well-being in June.

June 6 – National Yo-Yo Day

National Yo-Yo Day is the perfect day to get out your yo-yo and have some fun playing “Sleeper,” “Walk the Dog” and “Shooting the Moon.” Believed to be invented in ancient Greece, the Yo-Yo became popular in America when Donald F. Duncan Sr. manufactured the “Duncan Yo-Yo” in the early 1900s. You can visit the National Yo-Yo Museum in Chico, California.

June 7 – National Trails Day

National Trails Day is a celebration of America’s magnificent trail system and features a series of outdoor activities designed to promote the importance of the 200,000 miles of trails in the United States. Trails provide access to the natural world for recreation, education, exploration, solitude and inspiration, and they give us a means to support good physical and mental health. Pick a trail and breathe fresh air, get your heart pumping, and escape from stress.

Individuals, clubs and organizations from around the country host a wide array of trail activities: hiking, biking, paddling, horseback riding, trail running, bird watching and more. Check out the website for an official event being held near you.

 

Heath Jones, Healthways Coach-of-the-Year and member of the Innergy team at Healthways' Seattle Well-Being Improvement Center, is “Stepping It Up” in June as he gets ready for a 40-mile hike in Yosemite over Fourth of July weekend. In preparation, Heath will be hiking by himself or with a group every week, mountain biking twice with his friend Nick, logging at least four miles on the step-mill at the gym each week, and continuing his regular strength training routine. That's Heath training in the great outdoors of the Pacific Northwest!

June 14 – National Get Outdoors Day

National Get Outdoors Day encourages healthy, active outdoor fun. Prime goals of the day are to reach first-time visitors to public lands and reconnect youth to the outdoors. Participating partners will offer opportunities for families to experience traditional and non-traditional types of outdoor activities.

June 19 – National Recess at Work Day

Rich DiGirolamo, founder of Recess at Work, believes that to keep people engaged, loyal and productive, you need to create a work environment that is fun. But having fun at work and being a fun place to work are two very different things. Recess at Work is an opportunity to create team spirit, engage employees, increase morale, improve health and wellness, and share your fun side with your colleagues.

June 28 – Great American Backyard Campout

The Great American Backyard Campout is a part of the National Wildlife Federation’s efforts to help inspire Americans to protect wildlife, including a three-year campaign to get 10 million kids to spend regular outdoor time in nature. Thousands of people across the nation will gather in their backyards, neighborhoods, communities and parks to take part in this annual event that provides a fun-filled evening for all generations to get outside and connect with nature.

Topics: Healthy Living Well-Being In the News Exercise Workplace Well-Being Physical Health Health Emotional Health Community Daily Challenge Healthways Events Wellness Program

Need to Kick It Up a Notch with Your Wellness Program?

Sandy Cummings

Our friends over at Gallup have compiled some intriguing research, as always, about why corporate wellness programs often fall short of their goals -- plus what employers can do to turn things around. Check out this infographic:

0kejraousektlg-dvxfzvg

Discouraging data, given that programs designed to improve employee well-being have been shown to lower healthcare costs and improve employee productivity.

What steps can employers take to improve participation? Gallup researchers highlight the key role of managers in building awareness and trust, encouraging their teams to take part, and creating accountability for results. They also point out that programs that take well-being improvement beyond just the physical element -- in other words, that also work to elevate social, financial, community and purpose well-being -- have greater impact:

When comparing adults who are thriving in just Physical Well-Being with those thriving in all five elements, those in the latter group:

  • report 41% fewer unhealthy days
  • are more than twice as likely to say they always adapt well to change
  • are 36% more likely to say they always fully bounce back after an illness
  • are 23% more likely to donate money
  • are 43% more likely to have volunteered
  • are 65% less likely to be involved in a workplace accident
  • are 81% less likely to look for a new job when the job market improves

Read the full article here.

Topics: Well-Being Workplace Well-Being Engagement Business Performance Well-Being Index Competitive Advantage Motivation Productivity Healthways Wellness Trends Gallup Leadership