Imagine taking a break to relax, reaching into your pocket and drawing a long inhale on ... a tobacco-free electronic cigarette. It may not have FDA approval yet, but it is the latest innovation in series of products designed to aid smoking cessation.

Electronic cigarettes are designed to look, feel and taste like regular cigarettes, but instead of burning tobacco, users inhale a nicotine-based water vapor that is free from the carcinogens and tar that are found in cigarettes.

The electronic cigarette is powered by a microelectronic technology, a rechargeable battery and a refillable cartridge that contains nicotine, water, propylene glycol and a scent that resembles tobacco (or sometimes flavors like apple, vanilla, cherry, coffee and mint).

It releases a simulated smoke consisting of a water vapor mist that evaporates into the air. Those who don't want to include the nicotine can leave it out. People can use the electronic cigarette in places where smoking is banned, such as restaurants, bars, airplanes and worksites.

But can it be a tool to help people quit smoking? The World Health Organization says that hasn't been proven. It issued a warning last year, saying that "no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy."

"If the marketers of the electronic cigarette want to help smokers quit, then they need to conduct clinical studies and toxicity analyses and operate within the proper regulatory framework," says Douglas Bettcher, director of WHO's Tobacco Free Initiative.

The Food and Drug Administration has not approved the electronic cigarette for sale or import in the United States.

Due to the recession, some smokers are quitting (or at least trying to quit) to save money in their personal budget. Marketers of electronic cigarettes boast that they are less expensive than smoking cigarettes, partly because of high taxes on cigarettes. Electronic cigarettes are available through NJOY, Smoke Liberty and Smoking Everywhere.

Worksite programs

Time will tell whether companies will decide to integrate electronic cigarettes as a tool in the smoking cessation programs that they offer to their workers. So far, the electronic cigarettes haven't been marketed as a quitting aide.

Smoking carries a large cost for employers in terms of medical claims, absenteeism and lost productivity. "Tobacco use continues to be the No. 1 cause of preventable illness and premature death in the workforce. It costs U.S. businesses $167.5 billion per year in health care costs and lost productivity," notes Helen Darling, president of the National Business Group on Health.

Another problem is smokers loading up on nicotine at times when they know they won't be allowed to smoke for a while. Too much nicotine can "alter your ability to work safely and effectively," says Barry Beder, vice president of corporate health and productivity for AllOne Health, a provider of smoking cessation and wellness programs.

For every employee who quits smoking, the employer sees a savings of $5,000 per year, according to Mary Kate Salley, vice president of client services at Free & Clear, which provides smoking cessation programs. "Typically, tobacco users have two more sick days per year than nonsmokers," she says.

Thus, employers are most likely to be interested in a healthy alternative that can successfully reduce employee smoking rates and save a lot of money.

The ROI for smoking-cessation programs can be as high as 10:1, and the quit rates range from 20% to 70%, depending on the participation rate and the activities or services that the employer has implemented, Beder estimates. Ideally, the smoking-cessation program should be integrated with the employer's health plan, disease management program and employee assistance program, he says.

Under the health plan, employers should cover tobacco-cessation treatments and over-the-counter products for two quit attempts per year, according to Dr. Corinne Husten, vice president for policy development at the Partnership for Prevention, a group of employers and organizations that aims to prevent illness and improve health.

"There are effective treatments [including phone counseling and medications] that can double or triple the success rates," she adds. "Most people are not successful on the first attempt. The more attempts they make, the more likely they are to stay tobacco-free."

Fred Williams, director of health benefits management at Quest Diagnostics, agrees: "Paying for tobacco-cessation benefits is the single most cost-effective benefit that employers can provide."

After his company rolled out a smoking-cessation program, the percentage of employees who smoked dropped from 16% in 2005 to 12.5% in 2007. That's much lower than the national rate of 20%. Furthermore, 35% to 40% of employees who enrolled in the program have quit smoking.

Williams credits three ingredients for success: buy-in from senior management; employees who volunteered to champion the program; and aggressive and strategic communication via brochures, newsletters and a voice mail from senior management.

The future of smoking-cessation programs lies in creating more intelligent incentives, according to Arthur Carlos, CEO of the Vitality Group, a firm that offers a wellness program with a smoking-cessation component. "The evolution needs to be around how do you define the right incentive amount relative to the risk you want to change," he says.

It's best to have incentives that reward milestones along the way, rather than a simple incentive for enrolling, Salley says.

A recent study published in the New England Journal of Medicine found that financial incentives are more powerful than information alone. After 9 or 12 months, a group of smokers who received financial incentives had a 14.7% quit rate, compared to 5% for those who just received information.

"What it takes to quit is not information about lung cancer or heart disease or costs. It takes a kind of internal transformation, an 'aha' moment where somebody decides to do it because they choose to, not because they have to. The technology of helping smokers choose to quit, rather than having to quit, is a very important step," says Beder. "Most smokers want to be left alone. They want to do it on their own."

For that reason, AllOne Health provides CDs and audio files that smokers can listen to on their radio or iPod. "We've learned that we can't just make smokers feel bad, beat them up. We can't give them the same old messages," Beder notes.

Carlos recommends letting employees choose their own quitting method and informing them about the immediate risks and consequences of tobacco use, rather than the future risks and consequences. In addition, he says smoking-cessation programs are more effective when they are combined with a fitness regimen.

Associate Editor Kathleen Koster contributed to this report.