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Handling of e-cigarettes by some insurers, employers a drag for users

Popularity grows

• The e-cigarette was developed in 2003 in China by Hon Lik, a 52-year-old pharmacist, inventor and smoker, after his father, also a heavy smoker, died of lung cancer.

• In 2006, e-cigarettes were introduced in Europe and America.

• E-cigarette sales in the United States topped $500 million in 2012 and are expected to pass $1.5 billion this year.

• As of 2011, one in five U.S. adult smokers said they had tried an e-cigarette.

• Prices for e-cigarettes vary by brand, nicotine content and whether they're disposable or reusable. Prices for Blu, one popular brand, range from $37 for a pack of four disposable e-cigarettes to $80 for a starter kit that includes two bases, five cartridges and chargers.

• Blu says one disposable e-cigarette equals about 1½ packs of traditional cigarettes and claims one cartridge lasts about 250 puffs.

Sources: Centers for Disease Control and Prevention; the World Health Organization, The Consumer Advocates for Smoke-free Alternatives Association, Tribune-Review research

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Saturday, Sept. 21, 2013, 9:45 p.m.
 

Matt Frankle was 13 when he took his first drag on a cigarette.

Sixteen years later, Frankle declared enough was enough and is trying to kick his tobacco habit with the help of e-cigarettes — the controversial battery-powered cylinders that produce a nicotine-infused vapor giving smokers the breathe-in, breathe-out experience they crave.

Since January, e-cigarettes have worked, keeping him on the road, for the most part, to what he believes is a healthier life without the toxicity of tobacco.

So it baffles Frankle that some employers across the nation — UPS and Wal-Mart among them — are penalizing workers who use e-cigarettes with the same fees and higher insurance premiums sometimes assessed on users of traditional tobacco products.

Frankle, 29, of Pittsburgh feels fortunate that his employer, the state's Bureau of Disability Determination in Greensburg, doesn't impose tobacco-related penalties.

But he thinks it's “unreasonable to group (e-cigarettes) with cigarettes or other tobacco products ... especially because it's only nicotine and whatever's mixed in to vaporize it,” he said.

The debate about whether e-cigarettes are a healthy alternative to traditional cigarettes and whether they should be considered in the same vein as tobacco products has been raging internationally since the devices hit the market nearly a decade ago.

Many nations — including Germany, Italy, Poland and Portugal — have deemed the sale and use of e-cigarettes legal. The United Kingdom, which bans smoking tobacco in pubs, restaurants and other public places, now permits e-cigarettes in those places.

The Food and Drug Administration, which regulates many smoking cessation products, has said it intends to expand its jurisdiction to include e-cigarettes but has not yet issued those regulations.

A preliminary analysis of e-cigarette cartridges by the FDA in 2009 indicated some contain tobacco-specific nitrosamines, known cancer-causing agents, but found the amounts were comparable to those found in products such as nicotine gum and inhalers.

But some employers haven't waited for the FDA to weigh in on e-cigarettes, which come in flavors ranging from candy corn and apple pie to juicy peach, blueberry and caramel cappuccino.

Wal-Mart, which employes about 1.3 million people nationally, has been charging tobacco users higher insurance premiums for about three years and recently added e-cigarettes to the list, said spokesman Randy Hargrove.

Employees who use tobacco products pay a higher insurance premium, but Hargrove declined to say how much more. Wal-Mart considers cigarettes, cigars, pipes, snuff, chewing tobacco and electronic cigarettes to be tobacco products, Hargrove said.

Beginning next year, UPS will join Wal-Mart.

“I can tell you that self-identified smokers will pay an increased monthly premium beginning Jan. 31, 2014,” said UPS spokeswoman Ivette Lopez. “Nicotine e-cigarettes are considered a tobacco product for UPS.”

Debate over risk

The move has drawn fire from some who view e-cigarettes the same as other products that help smokers break their tobacco addictions.

“(Companies) should be basing their premium for health insurance on health risks, and the health risks of inhaling tobacco smoke are fairly well known,” said Elaine Keller, president of the Springfield, Va.-based Consumer Advocates for Smoke-free Alternatives Association.

“There is absolutely no actuarial evidence that e-cigarettes raise any risks for health because they are very much like the inhalers ... (used) to wean people down off nicotine,” Keller said. “There are no known cases of cancers, lung disease, etc. from those, so there's no reason to expect it from e-cigarettes.”

But Mitch Zeller, director of the FDA's Center for Tobacco Products, said that “we don't yet understand the effects of these novel tobacco products.”

Some local companies, including one local insurer, say the issue requires more study.

William Modoono, spokesman for UPMC Health Plan, said UPMC includes a tobacco use question on its medical questionnaire for individual and small group policies to help determine rates. At this time, the insurer does not collect information on e-cigarette use but is evaluating how to handle e-cigarettes starting next year.

Highmark Health Services spokesman Doug Braunsdorf said Highmark has a smoke-free workplace policy that bars using cigarettes, e-cigarettes, cigars and pipes. Although the company does not charge employees an extra fee if they use those products outside work, they are not eligible for discounts on premiums that nonusers can receive.

Tobacco surcharges have been growing nationally, with 42 percent of companies charging tobacco users higher rates, up from 35 percent last year, according to a survey by Towers Watson, a benefit consulting firm, and the National Business Group on Health.

In the Pittsburgh region, about 25 percent of employers surveyed reported charging an extra fee, up from 15 percent last year, said Chris Whipple, executive director of the Pittsburgh Business Group on Health.

“I'm thinking that will continue and could continue to grow,” Whipple said.

Some states restrict sales

Frankle said he's found e-cigarettes to be a more effective way to quit smoking than using gums and patches with nicotine.

With a patch, “Yeah, you get the nicotine, but that doesn't solve the something to do with your hands,” Frankle said. “(E-cigarette vapor) makes a cloud when it comes out of your mouth. It hits more of the behavioral aspects” of smoking.

That's one reason Bill Godshall, executive director of Smokefree Pennsylvania, said he's fought to keep e-cigarettes legal and accessible to people looking to quit smoking.

He said “e-cigarette prohibitionists” believe “you have to quit smoking the way we tell you to.”

“I've been fighting those asinine policies,” Godshall said. “Whatever helps you quit smoking, go for it.”

Because the popularity of e-cigarettes is relatively new, many states, including Pennsylvania, are only beginning to address their use. The first step in a handful of states — New York, Maryland, Kentucky, Tennessee and Arizona among them — has been to ban the sale of e-cigarettes to minors.

A report by the Centers for Disease Control and Prevention released this month found the number of students in grades 6-12 who reported using an e-cigarette doubled from 3.3 percent to 6.8 percent this year.

A proposal by state Sen. Tim Solobay, D-Canonsburg, would add e-cigarettes to the list of tobacco products one must be 18 to purchase. The measure, Senate Bill 1055, is before the Senate Judiciary Committee.

Kari Andren is a staff writer for Trib Total Media. She can be reached at 724-850-2856 or kandren@tribweb.com.

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