Only a few decades ago, Americans could smoke pretty much wherever they wanted. You could puff away on buses, in offices, restaurants and even airplanes with nary a thought. This behavior is far from the norm today, after years of intense pressure from public health and anti-smoking movements. But do e-cigarettes have the potential to re-spark smoking as a public activity?

E-cigarettes, or electronic cigarettes, heat a variety of compounds, flavorings and nicotine into a vapor that can be inhaled and exhaled like normal cigarette smoke. Sales of these devices have increased dramatically over the past few years, and while studies have looked at their effects on health, none have been conducted on the effects of e-cigarette use on observers.

In a study published May 21 in Tobacco Control, Andrea King, PhD, professor of psychiatry and behavioral neuroscience at the University of Chicago and her team did just this. They discovered that seeing people use electronic cigarettes (e-cigarettes) increases the urge to smoke among regular combustible cigarettes users, and that this elevated desire is as strong as when observing someone smoking a regular cigarette. The study is the first to investigate the behavioral effects of exposure to e-cigarette use in a controlled setting.

“E-cigarette use has increased dramatically over the past few years, so observations and passive exposure will no doubt increase as well,” King said. “It’s important to note that there could be effects of being in the company of an e-cigarette user, particularly for young smokers. For example, it’s possible that seeing e-cigarette use may promote more smoking behavior and less quitting. Whether participants were exposed to someone smoking a combustible or an e-cigarette, the urge to smoke a combustible cigarette was just as high in either condition,” she added.

With increasing e-cigarette sales nationwide, King believes that more attention needs to be placed not only on the health ramifications for users, but on the secondary, passive effects on observers.

“This study was our first investigation, and there are still many unanswered questions. We don’t know about the effects on a non-smoker or a person who has quit smoking or if responses are different for the various e-cigarette brands,” she said. “But if the results do generalize and we show this in other groups, it’s important to consider policy going forward in terms of reducing harm for both users and observers of e-cigarettes.”

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