Elsevier

Addictive Behaviors

Volume 37, Issue 8, August 2012, Pages 970-973
Addictive Behaviors

Short Communication
The electronic-cigarette: Effects on desire to smoke, withdrawal symptoms and cognition

https://doi.org/10.1016/j.addbeh.2012.03.004Get rights and content

Abstract

Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine via inhaled vapour. Few studies have evaluated acute effects on craving and mood, and none have explored effects on cognition. This study aimed to explore the effects of the White Super e-cigarette on desire to smoke, nicotine withdrawal symptoms, attention and working memory. Eighty-six smokers were randomly allocated to either: 18 mg nicotine e-cigarette (nicotine), 0 mg e-cigarette (placebo), or just hold the e-cigarette (just hold) conditions. Participants rated their desire to smoke and withdrawal symptoms at baseline (T1), and five (T2) and twenty (T3) minutes after using the e-cigarette ad libitum for 5 min. A subset of participants completed the Letter Cancellation and Brown–Peterson Working Memory Tasks. After 20 min, compared with the just hold group, desire to smoke and some aspects of nicotine withdrawal were significantly reduced in the nicotine and placebo group; the nicotine e-cigarette was superior to placebo in males but not in females. The nicotine e-cigarette also improved working memory performance compared with placebo at the longer interference intervals. There was no effect of nicotine on Letter Cancellation performance. To conclude, the White Super e-cigarette alleviated desire to smoke and withdrawal symptoms 20 min after use although the nicotine content was more important for males. This study also demonstrated for the first time that the nicotine e-cigarette can enhance working memory performance. Further evaluation of the cognitive effects of the e-cigarette and its efficacy as a cessation tool is merited.

Highlights

► The e-cigarette can reduce desire to smoke and nicotine withdrawal symptoms 20 minutes after use. ► The nicotine content in this respect may be more important for males. ► The first study to demonstrate that the nicotine e-cigarette can improve working memory.

Introduction

Electronic cigarettes (e-cigarettes) are battery-operated devices that deliver nicotine via inhaled vapour. Since no tobacco is burned, inhaling nicotine in this way potentially provides a safer alternative to smoking since it eliminates the harmful tars and carbon monoxide. E-cigarettes may therefore have a role to play in smoking cessation/reduction. Although their efficacy in this respect has not been empirically explored, quit rates in the region of 22–49% are indicated in two recent studies (Polosa et al., 2011, Seigel et al., 2011).

Any possible effect on smoking cessation/reduction, however, is unlikely to occur unless e-cigarettes are satisfying to use, and can effectively reduce desire to smoke and withdrawal symptoms. Bullen et al. (2010) reported significant and comparable reductions in desire to smoke with the 16 mg Ruyan e-cigarette and nicotine inhalator but both were less effective than regular smoking. A second study also reported reduced desire to smoke and some withdrawal symptoms although both e-cigarette brands tested failed to raise blood nicotine levels and heart rate over a 45 minute period (Vansickel, Cobb, Weaver, & Eissenberg, 2010).

That desire to smoke and withdrawal symptoms were reduced in the absence of raised blood nicotine levels is consistent with the notion that other sensorimotor factors contribute to its reinforcing effects. Several studies have demonstrated preference for smoking, reduced desire to smoke and withdrawal symptoms following the use of denicotinised tobacco (DT) (e.g. Rose, Behm, Westman, & Johnson, 2000) particularly in females (Barrett, 2010).

In addition to the putative reinforcing effects of sensorimotor aspects of smoking, smokers often report that it aids concentration and cognition (Hughes and Hatsukami, 1986, McEwen et al., 2008) and there is empirical evidence to support this assertion (see review by Heishman, Kleykamp, & Singleton, 2010). Nevertheless, whether nicotine derived via e-cigarettes can impact on cognitive processes has not been explored.

The present study aimed to explore whether the e-cigarette can reduce desire to smoke and abstinence-related withdrawal symptoms over a twenty minute period. To determine whether the nicotine content itself rather than other sensory factors associated with smoking (e.g. visual cues, buccal sensations) are responsible for these effects, we compared the nicotine e-cigarette, placebo e-cigarette and a ‘just hold’ group (to control for visual and tactile aspects of handing, but not using the e-cigarette). It was hypothesised that after 5 min, desire to smoke and withdrawal symptoms would decline in both the nicotine and placebo conditions relative to the just hold condition (consistent with a sensorimotor explanation). After 20 min however, when nicotine reaches peak plasma levels (Bullen et al., 2010), it was predicted that the nicotine group would show a further reduction in symptoms relative to the ‘just hold’ and placebo groups. Given previous reports suggesting the importance of sensorimotor aspects of smoking in women (Barrett, 2010, Perkins et al., 1999) data were explored separately by gender. We also included two short cognitive tests (to tap attention/speed of processing and working memory) to explore whether nicotine derived via the e-cigarette is capable of enhancing cognitive functioning.

Section snippets

Methods

In this mixed experimental design, 86 e-cigarette naive smokers (43 female; age range: 18–52 [mean: 28.8]) were randomly allocated to either 18 mg nicotine e-cigarette (nicotine), 0 mg e-cigarette (placebo; nicotine and placebo conditions administered single-blind) or just hold the e-cigarette (just hold) condition. The ‘White Super’ electronic cigarette was used (devices and cartridges supplied by The Electronic Cigarette Company) with a new tobacco flavoured cartridge for each participant.

Results

The three groups did not differ in age, gender, ethnicity or nicotine dependence (p > 0.15 in all cases). Mean FTND score was 5.2 (2.1). Guessing whether participants had received nicotine or placebo was at chance level: (χ2 (2) = 1.11, p > 0.05).

Discussion

Desire to smoke and some aspects of nicotine withdrawal were significantly reduced twenty (but not five) min after e-cigarette use; the nicotine e-cigarette was superior to placebo in this respect in males but not in females. Nicotine derived via use of the electronic cigarette also improved working memory performance particularly at the longer interference intervals.

The desire to smoke findings are consistent with Bullen et al. (2010) who reported that nicotine blood concentrations reached a

Role of funding sources

None.

Contributors

Dawkins and Turner designed the study. Hasna collected the data, conducted literature searches and ran preliminary analyses. Dawkins conducted further statistical analysis and wrote the first draft of the manuscript. Soar contributed to writing the manuscript and advised on the statistical analysis. All authors proof-read and approved the final version of the manuscript.

Conflict of interest statement

The first author has a collaborative relationship with Electronic Cigarette Company (TECC) who supplied the e-cigarettes and cartridges for this study. TECC had no involvement in the design or conduct of the study. All other authors have no conflicts of interest.

Acknowledgements

We would like to thank the participants who took part in this study and Dawn Markham and Tom Kent for their help in conducting the study.

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