Discussion

In summary, we find that current smokers are aware of and receptive to the blu eCigs television advert. Prior ENDS users held significantly more favourable views of the advert than non-users, but even non-users were fairly receptive to the advert. Interestingly, we found that viewing the advert elicited thoughts about smoking cigarettes and urge to smoke as well as thoughts about quitting smoking. We believe that the prominent visual cues in the advert may have triggered thoughts about smoking cigarettes and smoking urges; the actor was ‘vaping’ (the ENDS equivalent term to smoking) his blu eCigs (which look like traditional cigarettes) in common daily situations (eg, in a car) and exhaling vapour that looks very similar to cigarette smoke. Studies show that such visual cues can trigger urges to smoke.14 Additionally, smokers who are trying to quit smoking and suppressing their cravings end up thinking about smoking cigarettes more, pay more attention to smoking cues in their environment,16 and may even smoke more.17 These prior studies focused on cigarette smoking cues, but we believe they may also be relevant to ENDS because they are designed to look and function like cigarettes. The advert may have triggered thoughts about quitting because it noted that blu eCigs are a ‘smarter alternative to cigarettes’. To date, ENDS have largely been touted as a way to quit smoking cigarettes, and this is the primary reason smokers cite for initiating ENDS use.18 Our findings warrant further research on whether ENDS visual cues trigger smokers’ urges to smoke cigarettes or ENDS and whether smokers are substituting ENDS for cigarettes when they cannot smoke. In other studies smokers report using ENDS to circumvent smoking bans and to reduce cigarette smoking and associated harms.19 More research is needed on whether ENDS use encourages dual use with cigarettes, decreases cigarette consumption, and/or undermines cessation.

Currently, the FDA does not regulate ENDS marketing and labelling unless ENDS are advertised as a smoking cessation aid.20 Meanwhile, ENDS companies have been aggressively advertising their products across media channels (eg, magazines, internet), and advert expenditures are likely to increase2 as tobacco companies enter the ENDS marketplace.21 blu eCigs was acquired by Lorillard in April 2012 and generated US$114 million in net sales from January to June 2013.22 Altria's MarkTen and RJR's Vuse brand ENDS devices will be introduced in test markets in 2013.23

Our study has several limitations. First, although we attempted to account for the non-probability-based sample by using post-stratification weights, these results may not be generalisable to other populations of adult smokers. Indeed, rates of ENDS use reported in our survey are higher than those reported in previous studies using nationally representative samples,8 but it is unclear whether this is due to differences in sampling or the rapid increase in ENDS use in recent years. Second, we examined a single blu eCigs television advert so results are not generalisable to all ENDS television adverts. Third, the urge to smoke and thoughts about quitting smoking items did not specify a product, so we cannot determine whether respondents were referring to cigarettes or ENDS devices.

In conclusion, we find that smokers are receptive to a blu eCigs television advert and report intention to try ENDS devices after viewing the advert. Future studies should examine how exposure to ENDS adverts influences smokers’ use of ENDS devices, dual use with cigarettes, cessation behaviour and ENDS initiation among non-smokers and youth. Finally, researchers should continue monitoring ENDS advertising and its impact on consumer perceptions and behaviours.