According to the World Health Organisation, there are approximately 1.3 billion global users of tobacco. Each year, eight million die – a number which includes more than one million passive smokers. Governments globally are trying to reduce the number of people smoking but they are dealing with the issue in different ways.
The UK introduced a ‘swap to stop’ scheme in April that allows smokers to exchange their cigarettes for an electronic substitute. Health Minister Neil O’Brien heralded the initiative as a global first in a speech announcing its introduction as the UK looks to cut cigarette use to less than 5% of the population by 2030.
Whereas a month later, Australia effectively banned vapes, restricting them to prescription only, with prohibition increasingly becoming the weapon of choice in fighting cigarette consumption. Over 20 of the 35 countries in the Americas have restricted the sale of vapes, including eight outright bans; an approach which has also been used in India, Japan, Thailand, and North Korea.
So, is vaping bad for users, or not?
According to Tracey Johnson, Underwriting and Claims Manager at UK-based MorganAsh, which provides support services to the financial sector, the question is complicated.
“It’s easy to get confused about whether vaping is dangerous or not. Because the simple answer is that we don’t really know what the long term impact of using a vape will be. Research published in 2015 by Public Health England states that it has previously been estimated that e-cigarettes are 95% safer than smoking cigarettes. And it also shows that vaping is a fantastic tool for people looking to get away from smoking.”
Despite this the insurance sector still treats vaping the same as smoking. According to Zurich UK, anyone who has used nicotine in the last 12 months – or up to five years in the case of some carriers – will be classified as a smoker by life insurers and charged premiums double that of a non-smoker.
The same is true in the US. In 2016, the country’s Food and Drug Administration (FDA), ruled that e-cigarettes were to be considered as tobacco products and therefore subject to federal regulation, putting vapes and cigarettes in the same category.
According to Monideepa Chetia, Vice President of Underwriting at Longevity Services Incorporated, the implication for life settlements providers is that they should equally take the same approach when looking at policies.
“Until long-term health studies prove or disprove that e-cigarettes and vapes are less harmful than traditional cigarettes, the best way to deal with this in underwriting is to consider it as smoking or consider debits on a case– to– case basis.”
Andrew Gethin, Managing Director at MorganAsh, says that despite the Public Health England report, in the absence of granular data and extensive studies into the long term impact of vaping, it is easier for insurers to take a safety first approach.
“It’s just simpler to go yes or no: you are either a smoker or a nonsmoker, and someone who uses nicotine is a smoker. It’s a bit crude, but it comes down to the practicalities of where you get the data and how you prove it’s correct.”
Gethin also says that an older person who now uses a vape, even if it’s intended as a bridge to non-smoking status, is still likely to have smoked for a long time and therefore have the associated health impairments.
“Traditionally, underwriting practice was to require someone to give up smoking for 12 months prior to moving to no smoker rates. If they move to vaping with nicotine, then they are still using nicotine and hence still qualified as a smoker. From a risk point of view the damage from years of smoking does not disappear overnight,” he says.
The UK government may view vapes as an effective method to get people to stop smoking but evidence suggests it is also an easy way for young people to acquire a nicotine habit.
This was noted by O’Brien in his speech announcing the swap to stop scheme. Describing vaping as a ‘double edged sword’, the health minister said an unwelcome result of vaping was its use by younger age groups.
“There has been a very sharp increase in children vaping – particularly disposable vapes. NHS figures for 2021 showed that 9% of 11– to– 15 year old children used e-cigarettes, up from 6% in 2018. That’s a rapidly rising trend we need to stop,” O’Brien said.
Vaping may be safer than smoking but it isn’t without risk. One danger is nicotine itself; its consumption impacts blood pressure and increases the likelihood of blood clots and can negatively impact adolescent brain development.
Vaping potentially brings entirely new risks with it. In 2019, there was an outbreak of a lung condition termed EVALI – an acronym for ‘e cigarette or vaping use association lung injury’ – which was tracked down to the use of vitamin E acetate in vapes.
It is presumed that this substance is no longer used in vapes but they still contain a number of potentially harmful additives. The American Lung Association reports that vapes typically include carcinogens such as: acetaldehyde and formaldehyde, and metals including; nickel, tin and lead and diacetyl.
“There are risks associated with vaping. But statistically, it’s better to vape than it is to smoke,” says Johnson. “That may change because there’s an enormous amount of data out there and more is coming in all of the time. Currently we don’t really know what the longer term effects are.”
Johnson says these long term effects will not become clear until there are 10 to 20 years’ worth of mortality data to demonstrate the dangers of vaping, and with the product only being available since the early 2000s, and in widespread use for a decade, it is currently too early to make a definitive call.
The long term impact of vaping may be unclear but according to Johnson it appears to be safer than cigarettes with regard to passive smoking.
When someone applies for a life insurance policy and declares themself a non-smoker, insurers can ask them to take a cotinine test, which looks for metabolites of nicotine present in urine or saliva and is usually presumed to indicate the person is a smoker.
Johnson says that is impossible to trigger this test via second hand vape smoke, whereas research shows that people who live in house with at least one smoker can often test positive for cotinine – and are therefore exposed to the dangers of second hand smoke.
“There is no statistical evidence to suggest that passive smoking is a risk to other people living in the same household as someone who is vaping. There may be small elements of nicotine, and other chemicals, in the exhaled smoke but it isn’t enough to impact someone else’s health.”
