A recent RGA paper explores how vaping has emerged as a complex and uncertain risk for the Asia Pacific region, presenting evolving challenges for insurers as health effects, regulations, and usage patterns continue to shift.
Vaping has expanded rapidly across global markets and, despite being marketed as a safer alternative to combustible cigarettes, presents substantial uncertainty for life insurers.
Electronic nicotine delivery systems now occupy a prominent space in the broader tobacco and nicotine ecosystem, yet their long-term health impacts remain largely unquantified. This uncertainty, paired with rising youth uptake and evolving regulatory responses, creates unique challenges for risk assessment, underwriting, pricing, and portfolio management.
Drawing from an RGA research paper, this article synthesizes the evidence on vaping risks, regulatory variations, and health implications and explores the resulting considerations for insurers.
Vaping – inhaling an aerosol from an e-cigarette or vape – was introduced in the early 2000s and initially positioned as a harm-reduction alternative to smoking. However, usage patterns, especially among young adults and non-smokers, have complicated that narrative. The diversity of devices, ranging from disposable “cigalikes” to advanced mod systems and youth-popular pod devices, has contributed to rapid market expansion. The customizable nature of these devices, combined with thousands of available flavors and variable nicotine concentrations, has made standardized assessment difficult.
Vaping is an emerging risk for insurers primarily because of three factors:
The health consequences of chronic vaping remain unknown. Traditional cigarette risk relationships took decades to quantify, and current gaps in vaping-related research mean actuarial and underwriting assumptions must account for meaningful volatility.
The highest prevalence occurs in individuals aged 16-24. Youth uptake is driven by easy access, flavored products, social media exposure, and misconceptions about reduced harm. These patterns could influence morbidity and mortality trends for decades.
Many users combine vaping with combustible cigarette smoking. Dual use often results in higher nicotine intake and continued exposure to harmful toxicants. This increases health risk and complicates classification during underwriting.
While adult vaping prevalence remains low in many Asia Pacific markets, youth adoption is high even where vaping is banned. This divergence signals ongoing illicit access, inconsistent enforcement, and persistent social drivers that shape future risk pools.
Regulations across Asia Pacific are highly variable, reflecting differing philosophies and priorities on harm reduction versus prohibition.
Some markets – Hong Kong, India, Singapore, Taiwan, Thailand, and Vietnam – enforce comprehensive bans that encompass a variation of importation, sale, usage, and/or possession. In these markets, declines in official prevalence may mask illicit consumption supported by smuggling or underground distribution channels.
Other markets adopt a restricted approach. For example:
These regulatory differences influence accessibility, available product types, youth exposure, and data quality – directly affecting insurer visibility into risk behaviors. Even in tightly regulated environments, enforcement gaps allow the circulation of illicit products, which often lack quality controls. Such inconsistencies increase uncertainty surrounding product safety, chemical exposure, and user behavior.
For insurers operating in multinational portfolios, this regulatory fragmentation underscores the need for region-specific underwriting practices, continuous monitoring of legislative changes, and strategic partnerships with global reinsurers to effectively address vaping as an evolving risk.
Vaping most directly impacts the respiratory system. Short-term effects are similar to those seen in cigarette use: airway irritation, bronchial inflammation, and abnormal pulmonary function markers. Cases of e-cigarette or vaping product use-associated lung injury (EVALI) illustrate the potential severity of adverse events, including mortality. These cases often involve tetrahydrocannabinol (THC) or cartridges contaminated with vitamin E acetate, but they highlight broader safety challenges in unregulated supply chains.
Exclusive or dual e-cigarette use may reduce exacerbations for smokers transitioning away from cigarettes. Still, longer-term adverse effects may occur, including chronic obstructive pulmonary disease (COPD) development – although currently this is inconclusive.
Current evidence does not confirm increased cancer incidence, but early research indicates the presence of definite and probable carcinogens in aerosols, along with gene deregulation patterns similar to combustible tobacco. There have also been reports of cancer cases –bladder, breast, and head/neck – linked to e-cigarette use. Given the latency periods of cancer development, insurers should anticipate that forthcoming research may reshape morbidity and mortality expectations.
The release of catecholamine from nicotine e-cigarettes can increase heart rate, blood pressure, and arterial stiffness. Still, the evidence linking vaping to acute cardiovascular outcomes is limited. A few research findings show associations with myocardial infarction and heart failure, suggesting that vaping may not be free of cardiovascular risk. While former or infrequent users show weaker associations, daily users exhibit risk levels approaching those of conventional smokers.
Existing studies indicate nicotine exposure can influence cognitive and emotional development, especially in adolescents. This includes associations between vaping and mood, anxiety, impaired attention, and dependence. There is also conclusive evidence linking nicotine e-cigarette use to seizures. Some findings raise potential concerns about sleep disturbances, although evidence remains minimal.
Because nicotine crosses the placenta, there is the risk of it negatively affecting fetal development. To date, research is lacking on vaping’s impact on development during pregnancy, including low birthweight, pre-term birth, or small-for-gestational-age birth. This holds true for females who use nicotine-based vaping products only and those who are dual users.
Beyond inhalation toxicity and poisoning risks – more frequently reported in children younger than five – vaping devices pose physical hazards, including explosions that lead to burns and, in some cases, skin grafting. Environmental concerns include increased particulate matter, waste, and even fires.
Collectively, these health implications present significant uncertainty for insurers. While some risks align with those of traditional nicotine replacement therapies (NRT), many device-specific or chemical exposure risks are unique to vaping and continue to evolve.
Most insurers treat vaping as equivalent to smoking, applying smoker rates regardless of the product type or nicotine concentration. This stance is justified by unknown long-term effects, prevalence of dual use, and the addictive nature of nicotine.
However, RGA’s research suggests that underwriting refinement is both necessary and beneficial.
Current questionnaires tend to blend smoking and vaping into a single item, obscuring distinctions among former smokers, exclusive vapers, and dual users. Breaking down tobacco and nicotine behaviors into targeted questions can improve data quality and support more granular risk segmentation.
Detailed disclosures could include:
Such information enhances the ability to distinguish between short-term cessation-related usage and chronic, heavy exposure.
Actuaries should incorporate vaping as an explicit factor in mortality and morbidity models rather than bundling it with smoking. The RGA research highlights several quantifiable risks, such as elevated heart failure and myocardial infarction likelihood, and increased mortality among dual users. However, limitations in existing studies, such as small cohorts and short follow-up periods, require careful application.
Scenario analysis is essential to address uncertainty. Actuaries should model trajectories ranging from low health impact to emerging long-term risks (e.g., cardiovascular or respiratory diseases). These scenarios can inform risk margins, capital requirements, and strategic guidance for underwriting teams.
Continuous monitoring of regulatory changes is also critical. Shifts in market availability, product standards, or enforcement could rapidly alter usage patterns and risk pools.
Insurers face both adverse selection and non-disclosure risks if applicants underreport vaping habits, particularly in markets with bans where stigma or legal concerns may suppress transparency. Enhanced questionnaires that leverage behavioral science, cotinine testing (with limitations acknowledged), and clearer policyholder communication can mitigate these risks.
Collaboration across underwriting, claims, actuarial, and medical teams will support early recognition of emerging patterns in claims and health assessments.
Vaping presents a complex, evolving challenge for the insurance industry. While it may offer some harm-reduction benefits compared to combustible cigarettes, substantial uncertainties about long-term health outcomes – and clear evidence of short-term risks – require insurers to embrace proactive, adaptable strategies. Youth-driven adoption, regulatory variability, and device innovation amplify these challenges.
To manage this emerging risk effectively, insurers should strengthen underwriting strategies, enhance data capture, broaden scenario modeling, and maintain vigilant regulatory and medical surveillance. By doing so, the industry can navigate uncertainty responsibly while ensuring fair and consistent treatment of policyholders as evidence continues to evolve.
RGA experts are eager to engage with clients to better understand and tackle the industry’s most pressing challenges together. Contact us to learn more about RGA's capabilities, resources, and solutions.
