E-cigarette advertising makes one crave ... tobacco?

That is the finding by researchers Erin K. Maloney, Ph.D. and Joseph N. Cappella, Ph.D. from the University of Pennsylvania's Annenberg School for Communication, as reported in the journal Health Communication (online, March 2015).

The researchers studied more than 800 daily, intermittent, and former smokers who watched e-cigarette advertising, and who then took a survey to determine smoking urges, intentions, and behaviors.

Using a standard test to measure the urge to smoke a cigarette, people who smoke tobacco cigarettes daily and who watched e-cigarette advertisements with someone inhaling or holding an e-cigarette (aka vaping) showed a greater urge to smoke than regular smokers who did not see the vaping. Former smokers who watched e-cigarette advertisements with vaping had less confidence that they could refrain from smoking tobacco cigarettes than former smokers seeing e-cigarette ads without vaping.

The findings are significant, considering that tobacco advertising on television went up in smoke over four decades ago by way of a federal ban. Moreover, e-cigarette advertising is stoked by big tobacco companies. Estimates peg e-cigarette ad spending at more than $1 billion this year. That number is expected to grow at a 50 percent rate over the next four years.

"We know that exposure to smoking cues such as visual depictions of cigarettes, ashtrays, matches, lighters, and smoke heightens smokers' urge to smoke a cigarette, and decreases former smokers' confidence in their ability to refrain from smoking a cigarette," said Dr. Maloney. "Because many e-cigarette brands that have a budget to advertise on television are visually similar to tobacco cigarettes, we wanted to see if similar effects can be attributed to e-cigarette advertising."

Maloney and Cappella pulled together more than a dozen e-cigarette advertisements via searches of Google, YouTube, and e-cigarette web sites. They set up three conditions for the participants -- watching the advertisements, watching the advertisements with only the audio (the visuals were replaced by scrolling text of the advertisement), or simply answering a series of unrelated media use questions that took approximately the same amount of time it would take to view the advertisements. Participants were "daily," "intermittent," or "former" smokers.

Maloney and Cappella observed a trend that more daily smokers who viewed ads with vaping smoked a tobacco cigarette during the experiment than daily smokers who viewed ads without vaping and daily smokers who did not view ads. Over 35 percent of the daily smokers in the condition that showed vaping reported having a tobacco cigarette during the study versus 22 percent of daily smokers who saw ads without vaping, and about 23 percent of daily smokers who did not see any advertising.

"Given the sophistication of cigarette marketing in the past and the exponential increase in advertising dollars allotted to e-cigarette promotion in the past year, it should be expected that advertisements for these products created by big tobacco companies will maximize smoking cues in their advertisements, and if not regulated, individuals will be exposed to much more e-cigarette advertising on a daily basis," Maloney and Cappella wrote.

The editor of Health Communication, Teresa Thompson, Ph.D., University of Dayton, commented, "These findings are especially relevant to ongoing health and policy discussions, as they indicate that it is not just the health impact of e-cigs and vaping themselves that must be considered. The interrelationship between tobacco smoking and media representations of the 'e' versions examined in this study make clear that portrayal of actions that just look like smoking has an effect on viewers who smoke or used to smoke."