Exposure to electronic nicotine delivery systems (ENDS) visual imagery increases smoking urge and desire.

Abstract

Use and awareness of electronic nicotine delivery systems (ENDS; also known as electronic cigarettes or e-cigarettes) has increased rapidly in recent years, particularly among young adults. As use of ENDS resembles traditional smoking in both hand to mouth movements and inhalation and exhalation behaviors, we determined whether exposure to e-cigarette use via video exposure would act as a cue to elicit urge and desire for a combustible cigarette. Young adult smokers (mean age 26.3 ± 4.1 years) were randomized to view a brief video montage of advertisements depicting either e-cigarette vaping (n = 38) or bottled water drinking (n = 40). Pre- and post-cue exposure assessments were conducted in a controlled laboratory setting without other smoking or vaping cues present or behaviors allowed. Primary outcomes included change from pre-exposure baseline in smoking urge (Brief Questionnaire of Smoking Urges) and desire for a combustible and e-cigarette (visual analogue scales). Results showed that relative to exposure to the bottled water video, exposure to the ENDS video significantly increased smoking urge (p < 0.001) as well as desire for a regular cigarette (p < 0.05) and an e-cigarette (p < 0.001). These findings provide preliminary evidence that passive exposure to video imagery of ENDS use may generalize as a condition cue and evoke urges for a combustible cigarette in young adult smokers. It remains to be determined whether such increases in urge and desire correspond to increases in actual smoking behavior.

Effects of E-cigarette Advertising Messages and Cues on Cessation Outcomes

“…The lack of e-cigarette cue effects conflicts with results from previous experiments with smokers that found that e-cigarette images increased smoking urges 28 and sparked immediate smoking. 14 Because our measures of these outcomes were either identical or comparable to those in these previous studies, this leads us to speculate that the differences in results may be due to differences in stimuli.…”

“…In contrast to the print ads and 40-second total duration of exposure in our study, previous studies used video ads with stimuli exposure durations ranging from one minute to 4 or more minutes. 14,28 The longer duration of exposure and more vivid nature of the video ads may have resulted in a greater dose of the e-cigarette cue and, in turn, greater effects.…”

“…26,27 Ads featuring cigalikes might operate as combustible cigarette ads and undermine smoking cessation. Studies suggest that e-cigarette cues in video ads do indeed undermine smoking cessation by increasing smoking urges and desire 28 and stimulating smoking. 14 However, whether this effect generalizes to e-cigarette print ads is an open question.…”

Should e-cigarette use be included in indoor smoking bans?

“…For example, an experimental study among young-adult tobacco smokers reported that exposure to a video showing vaping significantly increased their urge to smoke as well as their desire for tobacco cigarettes and e-cigarettes 4 . Similarly, another experimental study found that exposure to the e-cigarette cue but not the tobacco cigarette cue also significantly increased desire to smoke an e-cigarette 5 …”

Should e-cigarette use be permitted in smoke-free public places? No

“…Given that smoke-free policies have been important drivers of smoking reduction and cessation,21 it is plausible that being able to vape in public places may in fact dampen decisions to quit or lead to relapse for many. Indeed, experimental evidence suggests that exposure to ENDS advertising22 23 and imagery24 may stimulate smokers and ex-smokers to try ENDS, smoke more cigarettes or relapse to smoking 16 17…”