Tobacco and electronic cigarette cues for smoking and vaping: an online experimental study

Abstract

Objective: This study examined whether exposure to smoking and vaping cues the urge to smoke or vape. It extends previous studies on first-generation cigalikes (visually similar to cigarettes) and second-generation devices (visually similar to pens) by including third-generation tank system devices (larger bulky units). In an online experiment, participants were randomly assigned to view one of four videos, which included smoking, vaping (cigalike or tank system), or neutral cues. The primary outcome was urge to smoke. Secondary outcomes were urge to vape, desire to smoke and vape, and intention to quit or remain abstinent from smoking. Results: UK adults varying in smoking (current or former) and vaping (user or non-user) status (n = 1120) completed the study: 184 (16%) failed study attention checks meaning 936 were included in the final analysis. Urges to smoke were similar across cue groups. Urges to vape were higher following exposure to vaping compared to neutral cues. There was no clear evidence of an interaction between cue group and smoking or vaping status. The lack of cueing effects on smoking urges is inconsistent with previous research, raising questions about the ability to assess craving in online settings.

Cue Reactivity to Electronic Cigarettes: A Systematic Review

“…Cue exposure to ENDS induced craving for ENDS was found in 10 studies. 66 , 68 , 70 - 76 , 78 Although Nichols et al 69 investigated this, they did not find a significant result. However, this study had a relatively small sample size (n = 7) and, therefore, a low statistical power.…”

“…Almost all studies (n = 19) used smoking participants (either exclusively smoking or dual users) in their experiments; of those, one compared smokers to former smokers and those who had never smoked, 65 one compared smokers to dual users, those who are exclusively ENDS users and those who are neither smokers nor ENDS -users 66 ; one compared daily to intermittent ENDS users to former smokers. 67 Of the remaining three papers that did not include smokers, one included participants who had never smoked and did not currently smoke, 68 one assessed only exclusive ENDS users, 69 and one included both current and former smokers but analysed the groups separately.…”

“…In addition, 18 studies 64 - 67 , 69 - 82 informed about the type (generation or commercial brand) of ENDS used in their experiments as cues (e.g., in person use or visualisation, in videos, advertisement, or printed ads) ( Table 1 ). Moreover, ENDS were used either as a unique active cue or compared with other ENDS generations or tobacco cigarette cues.…”

“…Moreover, ENDS were used either as a unique active cue or compared with other ENDS generations or tobacco cigarette cues. In this way, 10 studies used first generation ENDS, 64 - 67 ,69,73,75,77,78,80 five studies used second generation, 67 , 73 - 76 , 81 four studies used third generation 65 , 66 , 70 , 78 and two studies reported the use of fourth generation ENDS. 70 , 78 Furthermore, two studies reported the use of participants’ own ENDS (unspecified), 69 , 78 and two studies reported the commercial brand but not the ENDS specifications.…”

“…Cue exposure to ENDS was found to enhance craving for conventional (tobacco) cigarettes in 10 studies, 67 , 70 - 77 , 82 while eight studies reviewed did not demonstrate such a relationship. 65 , 66 , 68 , 78 , 79 , 83 - 85 To ensure that this dichotomy was not the result of study quality or design, the groups were compared for whether studies had been conducted in person or online, their number of participants, year of publication, the generation of ENDS used and the quality or Risk of Bias assessment. No differences were found.…”