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

Electronic nicotine delivery systems (ENDS), also referred to as electronic cigarettes or e-cigarettes, deliver nicotine to the user via inhalable aerosol derived from a nicotine-containing solution rather than smoke from burning tobacco as in combustible cigarettes (Grana, Benowitz, & Glantz, 2014). Globally, the popularity of these devices has increased in recent years (Pepper & Brewer, 2013; Regan, Promoff, Dube, & Arrazola, 2013; Vardavas, Filippidis, & Agaku, 2014; Zhu, 2013). In the United States, ENDS use has increased substantially with 49.6% of current smokers reporting ever use of ENDS in 2014 (Giovenco, Lewis, & Delnevo, 2014), an increase from 11.4% in 2010 (Pearson, Richardson, Niaura, Vallone, & Abrams, 2012). While ENDS are perceived as less harmful than combustible cigarettes (Pearson et al., 2012), their risk and health effects remain uncertain (Bastian & Oncken, 2014). Exposure to visual imagery depicting e-cigarette use via online and television advertisements has also increased rapidly in young adults (Duke et al., 2014; Durbin, 2014; Legacy Foundation, 2014; Pokhrel, Fagan, Kehl, & Herzog, 2015), among whom these advertisements have shown great appeal (Kong, Morean, Cavallo, Camenga, & Krishnan-Sarin, 2014; Pepper, Emery, Ribisl, Southwell, & Brewer, 2014; Trumbo & Kim, 2015). ENDS use shares many salient features of traditional cigarette smoking in terms of form and function, frequent hand to mouth movements, and inhalation and exhalation behaviors. As visual imagery of combustible cigarette smoking acts as a conditioned cue to elicit urges to smoke (McBride, Barrett, Kelly, Aw, & Dagher, 2006; Shmueli, Prochaska, & Glantz, 2010; Tong, Bovbjerg, & Erblich, 2007), it is possible that visual imagery of ENDS use could also generalize as a conditioned cue and elicit urges to smoke. Indeed, in our prior investigation, direct in-vivo observation of e-cigarette use evoked increases in young adult smokers’ urge and desire for a regular cigarette as well as for an e-cigarette, regardless of their e-cigarette use history (King, Smith, McNamara, Matthews, & Fridberg, 2014). Research on smokers’ exposure to e-cigarette use via television and internet advertisements has shown that viewers report urges to smoke (Kim, Lee, Shafer, Nonnemaker, & Makarenko, 2013), favorable product beliefs (Kim et al., 2013), and greater likelihood to smoke (Maloney & Cappella, 2015). While these online-based studies had large sample sizes, removal of other cues such as cigarettes, ashtrays, lighters, and smoking behavior during the assessments, was not possible. Thus, the goal of the present study was to extend prior research by examining the effects of exposure to video imagery of e-cigarette use in a controlled laboratory setting and comparing such responses to those exposed to nonsmoking video imagery. Young adult smokers were randomized to one of two video cue conditions (ENDS or bottled water, and assessed for smoking urge and desire before and after the exposures. The video material was extracted from television and internet advertisements retrieved online (see Methods). It was hypothesized that exposure to the e-cigarette video would evoke increases in regular smoking urge and desire for a regular cigarette, in addition to increases in desire for an e-cigarette.