5 Key Things HR Needs to Know about E-cigs in the Workplace

These key facts cut through the confusion about electronic cigarette use

E-cigarette use is rising, and if you’re confused about what to do about it,you’re not alone.

Conflicting media coverage about e-cigarettes—also called vaping—has many HR managers and benefit consultants punting to answer questions like:

• Are e-cigs as harmful as other tobacco products?• Should e-cigs be handled in a tobacco-free policy?• Is there a risk of secondhand smoke with e-cigs?

E-cigarettes prompt a host of mixed messages and claims. Some say theyhelp in smoking cessation by allowing people to taper off their nicotineuse gradually.1 Yet, e-cigarettes are not a cessation device approved bythe Food and Drug Administration (FDA) for quitting smoking.

To create solid workplace policies that focus on the health of your employees, cut through the confusion with these 5 key things to know:

E-cigarette is an umbrella term

E-cigarettes (or e-cigs) are a heterogeneous group of products that havenumerous names, including electronic cigarettes, electronic nicotinedelivery systems (ENDS), vaporizers, mods, and tanks.

These products can look very different from one another. For example, some e-cigs are designed to look like a traditional cigarette with a yellow “filter” section, while others look like flash drives, pens, highlighters, old-fashioned pipes, toys, or small boxes.

No matter what the shape, they have the same general components. A cartridge holds a liquid solution (often called “e-juice”) that contains varying amounts of nicotine, flavorings, and other chemicals. A heating

11 million adultscurrently use e-cigarettes1

Nearly

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element, called the atomizer, is powered by a small battery and works to heat the liquid solution to produce an aerosol, which is then inhaled.

Although using an e-cigarette is often called “vaping,” the devices produce an aerosol, not a vapor.

The most popular brand is JUUL, which claims about three-fourths of the e-cigarette market.3 It’s an example of the newest form of e-cigs, called“pod mods,” which have many flavor and device options. They appeal toconsumers because they’re easy to use, low maintenance, and can beused discreetly.

Because the products can contain variable amounts of nicotine and other chemicals, there’s no such thing as a “typical” e-cigarette. This variation makes it difficult to make recommendations about e-cigarettes as a product class. To date, e-cigarettes have not been reviewed by the FDA for use by adults or youth.

E-cigs can have substantial health effects

In 2016, the FDA commissioned the National Academies of Sciences, Engineering, and Medicine (NASEM)5 to review available research on the health consequences of e-cigarette use. After examining more than 800 studies, the committee noted:

Some chemicals present in e-cig aerosols are capable of causing DNA damage and gene mutations.

E-cigarette use results in symptoms of dependence.

2

In July 2017, only about 2% of teens and young adults used e-cigs. By December 2018, it had increased to more than 20%.

1 in 5 young people4

E-CIGUSE

There is moderate evidence that the risk and severity of dependence are lower for e-cigs than combustible tobacco cigarettes, but the type of device can be an important determinant of risk and severity of dependence.

Direct exposure to the e-liquid can be toxic, causing seizures, vomiting, and brain injury.

E-cigarette use increases airborne concentrations of particulatematter and nicotine in indoor environments, which means there isdanger in secondhand exposure.

Completely substituting e-cigs for regular cigarettes reduces exposure to toxins or carcinogens—however, almost 60 percent of e-cigarette users also smoke regular cigarettes.6

Devices can explode, causing burns and projectile injuries.

More research is needed to get a handle on the short- and long-term effects of e-cigarettes. In certain areas that were reviewed, there wasn’t enough conclusive evidence yet. This means consumers are using these products without a real understanding for potential harm.

Evidence about effectiveness for cessation is limited

One of the biggest questions that employers have is: do e-cigarettes actually help smokers quit? Because if the answer is yes, policies around banning them may seem counterintuitive for promoting tobacco cessation.

However, the NASEM committee found limited evidence that e-cigarettes are an effective aid to promote smoking cessation.

In fact, the committee noted there’s substantial evidence that e-cig use increases risk of using conventional cigarettes among youth and young adults. Nicotine is addictive and can have lifelong consequences when used by young people in any form. Early exposure to nicotine can lead to mood disorders, problems with impulse control, and attention and learning deficits.7

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Clear workplace policies on e-cigarette use are essential

Although e-cigarettes may help some people quit smoking, they are not an FDA-approved quit aid.

By including vaping in your workplace policy, you protect employees from exposure to the substantial health effects listed above, including secondhand exposure and potentially exploding devices.

Plus, you create a supportive environment for quitting. Few vapers use e-cigarettes exclusively; nearly 60% of e-cigarettes users also smokecigarettes.8 If any of them try to quit using combusted cigarettes, theymay prolong or intensify their addiction by using e-cigarettes at work. Byeliminating the possibility of continuing to use e-cigarettes at work, youincrease the likelihood that smokers can quit, and stay quit.

When drafting a workplace policy on e-cigarettes, there are several considerations to keep in mind:

Create a tobacco-free workplace policy that covers both indoor and outdoor workers. Only 80% of indoor workers in the U.S. are covered by a 100% smoke-free policy.9 Certain industries are less likely to have tobacco use policies, like farming, fishing, forestry, construction, and transportation. Additionally, 54%−75% of workers in these occupations were outdoor workers, and therefore may not have been covered under these policies, making them susceptible to secondhand smoke exposure in the workplace.10 But secondhand smoke exposure outdoors can be the same—or even higher—than in indoor settings.11 So, start by ensuring that your tobacco-free policy covers secondhand exposure among all employees, no matter where their work location.

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80% of indoor workers are covered by a 100% smoke-free policy.9

Only 54%−75% of outdoor workers have tobacco use policies.

Know what state and local laws are in place when it comes to e-cigarettes. The American Nonsmokers’ Rights Foundation can helpyou track down this information at www.no-smoke.org

Be consistent in how you address smoking and vaping. E-cigarettes are tobacco products, so it should not be treated separately.

Communicate with employees about the policy through companywide channels. Add it to the employee handbook and post notices about the policy throughout the workplace.

Highlight the availability of a cessation program for all the tobacco users in your company, and provide the tools and support your employees need to comply with your workplace policy.

E-cigarette users need tailored supportto quit

Although the component that drives addiction is nicotine, that doesn’t mean all cessation programs and efforts should be the same. E-cigarette users have unique needs when it comes to triggers and the ability to get a fix.

For example, some e-cig users are “secret addicts,” who can get a few quick hits in a bathroom stall without anyone knowing, or even at their desk if they can do it on the sly. That means they can vape all day, unlike smokers, who have to take breaks and leave the building to have a cigarette. Also, they might feel that vaping doesn’t have the negative connotation—or the negative health impact—that comes with smoking.

To help e-cig users quit, they need tailored support that includes information specific to the product they use, the triggers they face, their distinct health risks, and understanding about their specific circumstances.

Even if you have a few e-cig users—that you know about—in your organization, it’s possible that employees’ children may need nicotine addiction services. Or parents of young vapers might need support to understand how to help their child quit. Smokers in your workplace may also use e-cigarettes as part of their quitting approach or just to get through the workday.

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Remember, it’s

valuable to offer a

benefit to support

whole families being

free from addiction.

© 2019 Truth Initiative. All rights reserved.

It’s time for a new approach

The EX Program offers personalized support to each e-cigarette user and parent of a vaper.

Developed by Truth Initiative in collaboration with Mayo Clinic, the EX Program gives e-cigarette users and parents of vapers access to 1:1 live chat coaching, 24/7 social supportthrough on online community, text messaging support, and more.

Give your employees and their families the tools they need to quit tobacco. For good.

Visit www.theexprogram.com to learn more about our digital tobacco cessation program that helps smokers, e-cigarette users, and chewing tobacco users live tobacco free. Or contact us to see a demo today.

Sources

1 Mirbolouk M, Charkhchi P, Kianoush S et al. Prevalence and Distribution of E-cigarette Use among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med. 2018;169(7):429-438.

2 Hajek P, Phillips-Walker A, Przulj D, et al. A Randomized Trial of E-cigarettes versus Nicotine Replacement Therapy. N Engl J Med 2019; 380:629-637.

3 “Behind the Explosive Growth of JUUL,” Jan. 3, 2019, Truth Initiative.4 Truth Initiative, Media Monitoring Data, December 20185 National Academies of Sciences, Engineering, and Medicine (NASEM), Public Health Consequences of E-Cigarettes,

Washington, DC: The National Academies Press, 2018.6 https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations 7 Office of the Surgeon General. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.

Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.8 QuickStats: Cigarette Smoking Status Among Current Adult E-cigarette Users, by Age Group — National Health

Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:1177. 9 Syamlal G, King BA, Mazurek JM. Workplace Smoke-Free Policies and Cessation Programs Among U.S. Working Adults.

Am J PrevMed. 2019 Feb 14.10 Ibid11 Ibid