Newer e-cigarettes look much less like combustible cigarettes than their predecessors, which has led some to wonder whether they might not evoke smoking behavior in people exposed to their use. A recent study found otherwise. So-called vape pens, or vaporizers, stimulate young adult smokers to light up just as strongly as traditional smoke-and-ash cigarettes do.

The study, published in Nicotine & Tobacco Research, tested the vape pen’s effects on smokers 18 – 35 years old and found that passive exposure caused study participants to experience an immediate, significant and lasting increase in the desire to smoke. The effect extended to subjects who had never used the newer devices.

“Vape pens look different but they share too many salient features of the act of smoking—including inhalation, exhalation and hand-to-mouth behaviors,” study director Andrea C. King, PhD, professor of psychiatry and behavioral neuroscience and director of the clinical addictions research laboratory at the University of Chicago Medicine, said in a statement. “This makes them a potent trigger, encouraging people to smoke. Their impact is roughly equal to watching someone light up a cigarette.”

King and her co-authors recruited 108 volunteers, who ranged from very light to pack-a-day smokers, for a study they described as “assessing mood response to common tasks.” Through an hour-long session, the volunteers talked with a member of the research team pretending to be a fellow volunteer, who occasionally smoked either a combustible cigarette or a vape pen.

Both cues increased desire among research subjects for a cigarette or an e-cigarette, as measured by a questionnaire and two visual analogue scale items. The level and duration of desire was the same whether volunteers saw the research team member smoking a cigarette or using a vape pen. Participants reported having had no change in their desire to smoke or vape when the confederate drank bottled water.

Vape pens feature a more concentrated nicotine delivery system, as well as a wider variety of liquid and flavor options, than first-generation e-cigarettes. Controversy surrounds their health effects, with some vape proponents claiming they can help smokers break away from tobacco. Research has not been able to definitively confirm their effectiveness in smoking-cessation efforts.

“We’ve made real progress on reducing smoking in our country,” Dr. King said. “We’ve done a good job banning indoor smoking. We rarely see two-pack-a-day smokers like we used to. Yet seeing people smoke in public remains common. Our study focused on a classical Pavlovian trigger, as seeing someone smoke is a known potent cue that can induce others to smoke. We did not expect that the vape pen would be as potent a cue as the regular cigarette, but it was as potent.”

“The regulations in the U.S. on when and where somebody can use an e-cigarette are not yet standard,” she added. “But we do know that, so far, the use of e-cigarettes has not had a major direct impact on smoking cessation efforts above and beyond public health messages and taxes. The sight of someone using a vape pen bumps up the urge to smoke, so this may play a role in dual use of cigarettes and e-cigarettes, but future studies are needed.”

The authors acknowledged several limitations to the study, including reliance on a laboratory environment and a relatively small sample size.

The Food and Drug Administration (FDA) finalized a rule to regulate e-cigarettes in August, and this month it issued a final rule to clarify the definition of tobacco products. Meanwhile, some e-cigarette manufacturers and tobacco-industry lobbying groups have been maneuvering to have regulations on the latest generation of e-cigarettes rolled back or have their implementation delayed.

The AMA has policy supporting increased taxation of all tobacco products, including electronic nicotine-delivery systems, FDA oversight of e-cigarettes and many other tobacco products, and raising the minimum tobacco-purchasing age to 21. The AMA also says physicians should educate themselves about e-cigarettes, only promote FDA-approved smoking-cessation tools and resources and advise patients who use e-cigarettes about the potential danger to children of accidental ingestion of improperly stored e-cigarette liquid.

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