For many current smokers – and even former smokers – seeing others puffing on a cigarette can make it hard to resist lighting up. Television advertisements for electronic cigarettes can produce the same effect, according to a new study; they may encourage current and former tobacco smokers to reach for a conventional cigarette.

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US spending on e-cigarette advertising almost tripled between 2011 and 2012, from $6.4 million to $18.3 million.

Published in the journal Health Communication, the study reveals that daily smokers who witnessed e-cigarette use, or vaping, in TV commercials were more likely to crave a cigarette than regular smokers who did not watch the commercials. Former smokers who saw the ads reported a reduced ability to refrain from tobacco smoking.

Study authors Erin K. Maloney, PhD, and Joseph N. Cappella, PhD, of the Annenberg School for Communication at the University of Pennsylvania in Philadelphia, say their findings are important given the amount of money spent on e-cigarette advertising.

Last year, a study published in the American Journal of Preventive Medicine revealed that across all media channels, e-cigarette advertising expenditure in the US almost tripled between 2011 and 2012, from $6.4 million to $18.3 million, and spending is expected to grow significantly in coming years.

“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,” says the authors, “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.”

To reach their findings, Maloney and Cappella enrolled 884 participants to their study: 301 daily smokers, 211 intermittent smokers and 311 former smokers.

At study baseline, the participants took part in a standard test that assessed their urge to smoke conventional cigarettes.

The team then randomized the participants to one of three groups. The first group was required to watch e-cigarette TV commercials that contained visual cues – such as a person holding or inhaling an e-cigarette – while the second group watched e-cigarette commercials with no visual cues. The third group did not watch e-cigarette commercials. Instead, they were asked to answer unrelated media questions.

The participants’ urge to smoke conventional cigarettes was measured again through completion of the same standard test taken at baseline.

The researchers found that the urge to smoke tobacco was much higher among daily smokers who watched the e-cigarette commercials containing visual cues. In addition, 35% of daily smokers who watched ads with visual cues smoked a conventional cigarette during the experiment, compared with 22% of daily smokers who watched ads without visual cues and 23% of daily smokers who did not watch e-cigarette commercials.

What is more, former smokers who watched e-cigarette commercials with visual cues reported lower intentions to refrain from smoking tobacco cigarettes, compared with those who watched e-cigarette ads without visual cues and former smokers who did not watch e-cigarette commercials.

No significant differences in tobacco smoking urge were identified among intermittent smokers across the three groups, according to the team.

Maloney and Cappella explain their findings further in the video below:

Commenting on their results, the researchers say:

These data suggest that visual depictions of vaping in e-cigarette commercials increase daily smokers’ urge to smoke cigarettes and may lead to more actual smoking behavior. For former smokers, these cues in advertising may undermine abstinence effort.”

Teresa Thompson, PhD, of the University of Dayton, OH, and editor of Health Communication, says the team’s findings indicate it is not only the potential health effects of e-cigarette use itself that is a cause for concern.

“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,” she adds.

In December 2014, Medical News Today reported on a Cochrane review suggesting e-cigarettes are as “equally effective” as nicotine patches for helping smokers quit.