For employers, the use of e-cigarettes in the workplace can present challenges and potential health and safety risks. Mike Sopp investigates the issues.

Introduction

It is estimated that in the UK there are 2.1 million individuals, either current or ex-smokers of tobacco products, regularly using so-called electronic cigarettes (e-cigarettes).

Although some studies suggest that the use of e-cigarettes can decrease the use of tobacco-based products, there are concerns that the use of these devices may present unwanted side-effects.

The e-cigarette function

In the UK, around 1 in 5 adults, or about 10 million people, are current smokers. Smoking is the largest preventable cause of premature mortality in the UK, the harm being caused primarily through the toxins produced by the burning of tobacco.

It is well recorded that smoking can be an addictive habit, based on a complex combination of pharmacology, learned behaviour, genetics, and social and environmental factors. The presence of nicotine in smoking products is believed to be a key source of the addictive behaviour.

A report by the Royal College of Physicians concluded that “it is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug” and that “cigarettes are highly efficient nicotine delivery devices”.

It is estimated that around two-thirds of smokers want to stop smoking but figures suggest that only 8% of those who attempt to stop smoking do so for 2 years or more.

Electronic cigarettes, also known as vaporisers or electronic nicotine delivery systems (ENDS), have become increasingly popular since the mid-2000s among those who wish to cut down or stop smoking, to the extent that they are now the most popular single product used for this purpose.

There are estimated to be over 500 brands of e-cigarette worldwide, either disposable or rechargeable with replacement cartridges or reservoirs containing nicotine in a solution of either propylene glycol or glycerine/water and sometimes flavourings.

When an individual sucks on the device, a sensor detects the air flow and starts a process to heat the liquid inside the cartridge (powered by a battery), so it evaporates to form water vapour (through an atomiser).

Inhaling this vapour delivers a hit of nicotine straight to the lungs of the user. There is no side-stream smoke but some nicotine vapour is released into the air as the smoker exhales.

The good and the bad

Since the introduction of e-cigarettes, there has been considerable debate as to the benefits or otherwise of using them and the impact they may have on the “harm reduction” or cessation of tobacco smoking.

Organisations such as Public Health England, the British Medical Association and Action on Smoking and Health (ASH) have all issued position statements on the use of e-cigarettes.

In summary, it is thought that electronic cigarettes are proving more attractive to smokers than regulated nicotine replacement therapies, providing them with a safer alternative to cigarettes, and there is evidence that they can be effective in helping smokers stop or reduce smoking tobacco.

Public Health England, in a report published in May 2014, concluded that “electronic cigarettes, and the various new generation nicotine devices in development, clearly have the potential to reduce the prevalence of smoking in the UK. The challenges are to harness that potential, maximise the benefits and minimise risks”.

As with the potential to reduce smoking, there are a number of issues and concerns related to e-cigarettes including:

  • the health impact of unregulated and variable doses of nicotine on the user

  • the presence of potentially unsafe chemicals in the unregulated products

  • public concerns over exposure to vapour substances

  • the “normalisation” of using nicotine and potential gateway to smoking

  • the attractiveness of e-cigarettes to younger persons

  • the prevention of individuals from stopping smoking altogether by adopting “dual-use” behaviours.

In 2014, the World Health Organisation (WHO) published a report into the use, health effects and options for regulating e-cigarettes. The report acknowledged that devices are likely to be less harmful than conventional smoking, but warned that their use “may potentially increase the background air levels of nicotine and other substances which could be harmful to adolescents and pregnant women”.

Of interest, WHO recommended a legal ban on the indoor use of e-cigarettes and other such devices “as there is no clear evidence yet that exhaled vapour from e-cigarettes is not harmful to bystanders and does not undermine the enforcement of a smoke-free policy”.

Many academics have commented on the WHO report challenging its findings and recommendations.

As well as health risks, there can be safety concerns. A number of fires have occurred during the charging of e-cigarettes, particularly when the wrong type of charger has been used. Fires have contributed to at least two deaths in domestic properties as well as fires in commercial properties, prompting the Chief Fire Officers’ Association to release a warning statement.

Employers and e-cigarette usage

The use of e-cigarettes is an emotive issue but according to ACAS, employers should decide whether to allow employees to smoke e-cigarettes, and similar products, in the workplace or ban them as they would ordinary smoking implements.

Bans have been introduced in some countries through regulatory powers, while in the UK a number of notable organisations are now banning the use of e-cigarettes by both employees and the public.

From a government viewpoint, the Department of Health said that no legislative ban was planned in England, but measures to curb e-cigarette use in public places are already under consideration in Wales.

Therefore, at present, it is down to each organisation to set policy on the use of e-cigarettes in the workplace.

A briefing note produced by ASH in conjunction with other public health bodies can be used as a useful starting point for developing a suitable policy. It suggests employers should:

  • be clear about what they are trying to achieve through the policy (eg better health, public image)

  • be clear about precisely what they are prohibiting (nicotine-containing products, items that could be confused with cigarettes, or both)

  • make sure the policy is good for health by helping and not hindering smokers to reduce the harm caused by smoking

  • consider the part the policy can play in “renormalising” or “denormalising” the smoke-free environment.

There may be a concern that preventing the use of e-cigarettes in the workplace may hinder those who use them to stop smoking (rather than as a casual substitute), particularly if they are required to smoke them in designated smoking areas together with cigarette smokers.

As such, employers may want to consider organising a separate dedicated e-cigarette smoking area external to work premises. Other actions to take may include:

  • giving clear guidance on breaks to use e-cigarettes

  • support in giving up smoking and eventual cessation of nicotine replacements

  • encouraging employees to use alternatives to e-cigarettes

  • prohibiting the charging of e-cigarettes in the workplace (from a fire safety viewpoint).

By May 2016, the UK Government will be required to transpose the European tobacco products directive into national law. Some e-cigarettes (which may include those with strengths over 20mg/ml) will be regarded as “medicinal products”. Employers that impose a wholesale ban on using nicotine devices in the workplace may face complaints in the future from employees who have been prescribed them as medicine and must, therefore, be prepared to explain the reasoning behind the ban.

Last reviewed 5 March 2015