The Effects of E-Cigarette Visual Appearance on Craving and Withdrawal Symptoms in Abstinent Smokers

Electronic cigarette (e-cigarette) use is becoming increasing popular among smokers and there is a plethora of devices available. Nicotine delivery is clearly important for reducing tobacco craving and withdrawal symptoms, but other sensor-motor aspects of e-cigarettes (such as visual appearance) may contribute to this effect. This study explored whether it is important for an e-cigarette to visually resemble a tobacco cigarette in order to reduce craving and withdrawal symptoms. Sixty-three cigarette smokers (40% female, aged 18-65 years) who were not current e-cigarette users were randomly allocated to take ten 3-second puffs from either a white or a red first generation e-cigarette following overnight abstinence. Current craving (urge to smoke) and nicotine withdrawal symptoms (using the Mood and Physical Symptoms Scale; MPSS) were measured before and ten minutes after use. Linear regression revealed higher craving and withdrawal symptoms in the red versus the white condition but only among those who were e-cigarette naive (craving: B = .76, p = .009; withdrawal symptoms: B = 2.18, p = 0.009), not among those with e-cigarette experience (craving: B = -.08, p = 0.89; withdrawal symptoms: B = .24, p = .81), and these effects differed between groups (p = 0.04 and 0.01 for craving and withdrawal symptoms respectively). To conclude, cigarette-like appearance was associated with lower craving and withdrawal symptoms but only for those with no prior e-cigarette experience. This effect, putatively mediated via classical conditioning or expectancies, may aid understanding of smokers’ initial preferences for ‘cigalike’ e-cigarette devices.