Smoking indoors is making a comeback. But take a closer look. Are those really clouds of smoke? These days, the chances are good that what you are actually seeing is vapour released from electronic cigarettes. While some are fuming about e-cigarettes and their potential health risks, there is no doubt that the devices are quickly rising in popularity, which can impact a range of public spaces, including the workplace.

What are e-cigarettes?
An e-cigarette is a small battery-operated device made to resemble a traditional cigarette. There are three main parts to an e-cigarette: a replaceable inhaler cartridge that contains a liquid chemical mixture; a heating chamber which turns the liquid into a vapour; and a battery with an LED light at the tip that glows like a cigarette when inhaled. Using an e-cigarette is known as "vaping," referring to the vapour that is produced.

Although they mimic the look and feel of a cigarette, these electronic devices vaporise a solution instead of burning tobacco. The solution may be composed of various amounts of nicotine, propylene glycol, and other chemicals, some of which may be harmful.

Are e-cigarettes legal?
In Canada products that contain nicotine fall within the scope of the Food and Drugs Act, and because they have not been granted a market authorization, they cannot be imported, advertised or sold. E-cigarettes that do not make any health claim and do not contain nicotine may legally be sold in Canada. However, in March 2009, Health Canada issued an Advisory to Canadians not to use e-cigarettes as these products may pose health risks and have not been fully evaluated for safety, quality and efficacy by Health Canada.

In the U.S., the import, sale, advertising and use of e-cigarettes is allowed, although some states have their own regulations in place. In April 2014, the U.S. Food and Drug Administration (FDA) issued a proposed rule that would extend their tobacco authority to cover e-cigarettes. Among other requirements, makers of e-cigarettes would have to register their products, report ingredient listings, and include health warnings. In addition, sales to minors would be banned.

Are e-cigarettes safe?
While e-cigarettes are free of tobacco, most solutions contain nicotine, which is highly addictive, and can affect the cardiovascular system and blood sugar levels, and propylene glycol, which is a known irritant.

In June, a group of 129 physicians, epidemiologists and other experts from 31 countries sent an open letter to the World Health Organization (WHO). They warned that although e-cigarette vapour has fewer toxic components than regular smoke, more than half a dozen studies have shown it can include ultrafine particles damaging to lungs, plus "carcinogens and reproductive toxins, including benzene, lead, nickel, and others." The WHO has been reviewing the existing evidence around electronic nicotine delivery systems (ENDS) - including e-cigarettes. In August 2014, they released a report that called for regulations to end the use of e-cigarettes in public and workplaces. Evidence suggests that exhaled e-cigarette aerosol increases the background air level of some toxicants, nicotine and particles.

When the FDA conducted limited laboratory studies of certain samples, it found significant quality issues that indicate substandard or non-existent quality control processes. Potential issues include inaccurate information on ingredient concentrations, the presence of toxic impurities, and products labelled nicotine-free actually containing nicotine. A Canadian Cancer Society-commissioned study found similar results with misleading labels and products incorrectly labelled as "nicotine-free."

Smoking cessation tool or gateway device?
According to the Conference Board of Canada, the cost to employers for each worker who smokes is estimated to be $4,256, due to reduced productivity and absenteeism. To help employees who want to stop smoking, a number of companies and organizations sponsor or subsidize smoking cessation programs.

Advocates of e-cigarettes say that e-cigarettes provide smokers with a safer alternative to traditional cigarettes, or help them quit altogether. The regulatory classification of e-cigarettes as tobacco products, they argue, would negate their potential to reduce the death and disease caused by smoking.

Others believe that the electronic devices may serve as a gateway to nicotine addiction by luring teen and non-smokers. According to a Canadian Cancer Society-commissioned survey, nearly a quarter of 18-24 year olds have used e-cigarettes, compared to nine percent of the general population.

The Canadian Lung Association encourages people to avoid unproven methods, like e-cigarettes, and to quit smoking using proven methods like individual or group counseling, stop-smoking medication and nicotine replacement therapies such as gum, patches, lozenges, and inhalers.

Workplace considerations
All Canadian jurisdictions have a formal law or regulation that restricts smoking in the workplace. Smoking is completely prohibited in Ontario, Nova Scotia, Quebec, Manitoba, New Brunswick and British Columbia workplaces. Some provinces allow a separately ventilated room to be built in the workplace. But should e-cigarettes be counted as smoking?

While they technically do not emit smoke, e-cigarettes do release a vapour into the air. Several substances have been detected in the vapour from e-cigarettes, including nicotine, propylene glycol, flavourings and heavy metal traces. Many Canadian jurisdictions do not have specific legislation that deals with indoor air quality issues. In the absence of such legislation, the "general duty clause" applies. This clause, common to all Canadian occupational health and safety legislation, states that an employer must provide a safe and healthy workplace. Thus, making sure the air is of good quality is the employer's duty.

Until more is known about the short-term and long-term health effects of e-cigarettes, and until they are approved for use in Canada, it is advisable to proceed with caution and to not allow their use in the workplace.

Source: Canadian Centre for Occupational Health and Safety www.ccohs.ca

Resources

Electronic nicotine delivery systems PDF, World Health Organization (WHO)

Health Canada Advises Canadians Not to Use Electronic Cigarettes, Health Canada (archived statement)

Electronic Cigarettes (e-Cigarettes), U.S. Food and Drug Administration

Indoor Air Quality Fact Sheet, CCOHS

Environmental Tobacco Smoke (ETS): General Information and Health Effects, CCOHS

Ways to quit, Canadian Cancer Society

E-cigarettes - QuitNow, BC Lung Association