Health Risks

Vaping instead of smoking

Electronic cigarettes – so-called "e-cigarettes" – are becoming more and more popular. Smokeless non-tobacco cigarettes have been around since the early 1960s. But it was not until 2003 that the Chinese chemist Hon Lik patented the modern e-cigarette. Business has been booming in recent years: advertising emphasises the health benefits of switching from traditional cigarettes to e-cigarettes, using celebrity endorsements, dedicated websites and specialised walk-in shops. In the UK alone, the number of users is estimated to be 1.3 million.


E-cigarettes are battery-powered devices, sized and shaped to look like traditional cigarettes. They contain an atomiser and a heating coil that vaporises a liquid nicotine solution. The vapour produced is inhaled and the body takes up the nicotine via the lungs. The impression of smoking a traditional cigarette is thus reproduced at the same time.   For insurers, the question that now arises is whether e-cigarettes really are a safer alternative to smoking. And if so, what are the implications for carrying out risk assessments of applicants who use e-cigarettes instead of traditional cigarettes?

A safer alternative?

While it is the highly addictive nicotine that keeps smokers addicted to cigarettes it is the chemicals in their tobacco smoke that kills around half of all long-term users. Tobacco cigarettes contain around 4,000 different chemical compounds, including toxins like arsenic and hydrogen cyanide. Tobacco smoke has long been recognised as a carcinogen responsible for more than one in four UK cancer deaths. Traditional tobacco cigarettes are the biggest single cause of cancer in the world. It is generally agreed that e-cigarettes are probably a safer way of introducing nicotine into the body. Nevertheless, many questions remain, as e-cigarettes also release many chemicals. Given the lack of regulation, often inaccurate declarations of the content, many different suppliers and very different product lines, there is currently almost no way of checking the inhalants' effects on health. What's more, the same marketing that extols them as a safer alternative to smoking also makes them attractive to young people who do not currently smoke. Advertising is thus deliberately aimed at young users, for example in social media. E-cigarettes are marketed as a trendy accessory, thereby pushing the nicotine inhalation aspect into the background. The UK's ban on tobacco advertising does not apply to e-cigarettes. The fear that this could encourage ex-smokers, non-smokers and children to smoke, by playing down and promoting nicotine addiction, has not so far been substantiated. Reassuringly, frequent (more than weekly) use of e-cigarettes in young people aged 11 to 18 has been shown to be confined almost entirely to ex-smokers and daily smokers. There are fears among the medical profession that this opens up a gap in the market for the tobacco industry, which may try to gain more consumers by increasing the nicotine content.

The taste of freedom

A decisive factor for the attractiveness of e-cigarettes will be the extent to which their use becomes acceptable in traditional non-smoking areas. The supposed freedom of users to smoke anywhere is in fact one of the points that the advertising for e-cigarettes makes. Indeed, the UK already has its first e-cigarette "vaping zones", like the one at Heathrow Terminal 4. In order to combat the downplaying of the health risks posed by e-cigarettes, be able to demand a clear declaration of the ingredients and prevent these products from being freely available to young people, from 2016 the UK's Medicines and Healthcare Regulatory Agency (MHRA) will be making e-cigarettes subject to the same licensing requirements as those applying to classic nicotine replacement therapies such as patches and gum. In the USA, a restrictive position like the one in the UK has been adopted. The U.S. Food and Drug Administration (FDA) is planning to extend the regulatory rules for other tobacco products to e-cigarettes. The aim is to increase the safety of e-cigarettes and limit the availability of the devices and liquid mixtures to adults.

Consequences for underwriting

It is likely to be quite some time before there are any long-term studies available on how long smokers stay with e-cigarettes or how often they fall back into their normal smoking habits. In recent research carried out by ASH (Action on Smoking and Health), smokers and ex-smokers reported different reasons for using e-cigarettes. The main reasons ex-smokers report having used e-cigarettes is to help a quit attempt (48%) and “to help me keep off tobacco” (32%). The main reason smokers report having used e-cigarettes is to “help me reduce the amount of tobacco I smoke, but not stop completely” (31%) followed by help in a quit attempt (30%), and then “to help me keep off tobacco” (29%). A further complication from an underwriting perspective is that laboratory tests used to provide evidence of nicotine consumption do not distinguish between smokers of normal cigarettes and e-cigarettes. A recent survey conducted at a conference of home underwriters in the USA revealed that 40% of insurance companies had established an underwriting policy on e-cigarettes, and 80% of these classified e-cigarettes as tobacco products (see below for key survey results). In the absence of detailed long-term studies on the safety and impact of using e-cigarettes, Munich Re currently recommends to carefully consider how e-cigarette users should be categorised. Proposal forms should therefore ask about the use of tobacco substitute or nicotine replacement products of any kind – including patches, gum and e-cigarettes.