Attentional bias in young adult tobacco cigarette smokers and e-cigarette users: an eye-tracking study

Attentional bias (AB) is a key behavioural feature known to contribute to the maintenance of tobacco use; however, little information exists on whether e-cigarette users display an AB.

We aimed to measure differences in AB between exclusive cigarette smokers and exclusive e-cigarette users. Our secondary aim was to compare overnight abstinence and sated conditions on AB within e-cigarette users and cigarette smokers.

Participants included exclusive e-cigarette users (n = 28), cigarette smokers (n = 29), and healthy non-nicotine-using controls (n = 18). AB was measured using a free-viewing eye-tracking task. Participants were shown 85 slides, each containing 4 competing images, with test images relating to one of the following cue categories; vaping, smoking, and competing smoking versus vaping. The primary outcome was relative fixation time (RFT) (in ms). AB was determined by subtracting the mean RFT of the neutral images from the mean RFT of the test images.

E-cigarette users exhibited significantly higher AB towards vaping-related (d = 1.107, p = 0.002) and smoking-related cues (d = 0.1080, p = 0.001) compared to non-using controls. Additionally, e-cigarette users and cigarette smokers both showed a preference for their product's cues in the competing smoking versus vaping cue category. The only difference observed between the abstinent and sated states was cigarette smokers showing a greater preference for smoking-related cues over vaping-related cues in their abstinent state compared to sated (d = 0.644, p < 0.001).

E-cigarette users show AB to both vaping- and smoking-related cues, suggesting possible AB transfer between the two products. AB does not appear to be sensitive to acute withdrawal states.