The Smoking Dilemma: A Technical Deep Dive

Traditional cigarette smoking has declined markedly over recent decades due to increased health awareness, regulatory action, and public health campaigns. At the same time, alternative nicotine products, particularly e-cigarettes and oral nicotine pouches, have gained popularity, especially in the United States and Europe and among younger populations. While cigarettes remain the most widely used tobacco product globally, tobacco and nicotine consumption now spans a broad range of combustible and non-combustible products, with smokeless tobacco predominating in some regions. Definitions of a "smoker" vary significantly between clinical practice and insurance medicine. Clinical definitions are nuanced and health-focused, whereas insurance classifications are typically binary and time-bound, often defining a smoker as anyone who has used a nicotine-containing product within the past 12 months. The growing use of alternative nicotine products, alongside evolving cannabis legislation, has exposed limitations in traditional definitions when it comes to accurately capturing associated risk. The expansion of alternative nicotine products challenges traditional smoker classifications used in insurance underwriting. While combustible tobacco remains the highest risk exposure, growing evidence supports the existence of a heterogeneous medium risk group associated with nicotine, noncombustible products. Although generally lower risk than cigarettes, these products are not risk-free, particularly considering early cardiovascular and metabolic effects, dual or poly-use patterns, and growing uptake at younger ages. For insurers, this evolving landscape highlights the benefit of a more nuanced underwriting approach, including enhanced disclosure of product type and use patterns, improved verification strategies, and potential pricing differentiation that better aligns risk with exposure.