1
|
Mercincavage M, Waugh LK, Gratale S, Wackowski O, Pearson JL, House K, O'Connor R, Strasser AA. Acute effects of charcoal filters and package color on cigarette perceptions and use behaviors: Results from a randomized pilot study examining Natural American Spirit "Sky". Drug Alcohol Depend 2024; 255:111080. [PMID: 38198898 PMCID: PMC10843540 DOI: 10.1016/j.drugalcdep.2024.111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Charcoal-filtered cigarettes have been available for decades but have never held a major share of the U.S. cigarette market. This pilot study gathered initial behavioral data characterizing how "Sky"-a recently introduced charcoal-filtered cigarette variety that uses potentially misleading marketing features-is used and what impact its packaging color has on consumer perceptions. METHODS Forty adult daily non-menthol cigarettes users (52.5% male, 75.0% White, mean age = 46.1, 14.3 mean cigarettes/day) completed a single-session deception study utilizing a 2 ×2 mixed factorial design to manipulate cigarette filter condition (charcoal vs. non-charcoal) and pack color (light vs. dark). Participants smoked two cigarettes identical in appearance and packaging but differing in filter type (blinded and order counterbalanced) and completed pre- and post-cigarette CO samples and post-cigarette questionnaires. RESULTS Participants endorsed more favorable subjective ratings, puffed less of, held more correct beliefs about risks, and expressed greater intentions to use the charcoal (vs. non-charcoal)-filtered cigarette (p's <0.05). Pack color had few effects on outcomes; however, cigarettes in light vs. dark colored packs were rated as cleaner tasting (p <0.01). Neither filter condition nor pack color affected CO boost. There were no interaction effects on any outcomes. CONCLUSIONS Under blinded conditions, Sky charcoal-filtered cigarettes are initially appealing independent of their packaging color. Findings warrant further study of these effects on perceptions, behavior, and harm exposure after longer, open-label use periods. Findings may inform regulatory decisions regarding cigarette packaging and filter composition.
Collapse
Affiliation(s)
- Melissa Mercincavage
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Lizza K Waugh
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stefanie Gratale
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Olivia Wackowski
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Jennifer L Pearson
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Nevada-Reno, Reno, NV, United States
| | - Kendra House
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Richard O'Connor
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Andrew A Strasser
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| |
Collapse
|
2
|
Vukas J, Mallock-Ohnesorg N, Rüther T, Pieper E, Romano-Brandt L, Stoll Y, Hoehne L, Burgmann N, Laux P, Luch A, Rabenstein A. Two Different Heated Tobacco Products vs. Cigarettes: Comparison of Nicotine Delivery and Subjective Effects in Experienced Users. TOXICS 2023; 11:525. [PMID: 37368625 DOI: 10.3390/toxics11060525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Heated tobacco products (HTPs) produce aerosol using a different mechanism than tobacco cigarettes, leading to lower emissions of some harmful substances, but also of nicotine as reported by some independent studies. Lower nicotine delivery could lead to compensatory puffing when product use does not sufficiently satisfy cravings. Thus, this three-arm crossover study was conducted to characterize the potential of two different HTPs to deliver nicotine and satisfy cravings compared with conventional cigarettes in users who had already switched to HTPs. Fifteen active, non-exclusive HTP users consumed the study products according to a pre-directed puffing protocol. At predetermined time points, venous blood was sampled and the subjective effects of consumption were assessed. Nicotine delivery by both HTPs was comparable, but significantly lower than that by conventional cigarettes, suggesting a lower addictive potential. Cravings were reduced by all products, with no statistically significant differences between them, despite the different nicotine deliveries. This indicated that HTPs do not necessarily need high nicotine deliveries with high addictive potential, as are characteristic of tobacco cigarettes. These results were followed up on with an ad libitum use study.
Collapse
Affiliation(s)
- Jochen Vukas
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| | - Nadja Mallock-Ohnesorg
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| | - Elke Pieper
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Luna Romano-Brandt
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| | - Yvonne Stoll
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| | - Lukas Hoehne
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| | - Nestor Burgmann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| | - Peter Laux
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich (LMU), Nussbaumstrasse 7, 80336 Munich, Germany
| |
Collapse
|
3
|
Foulds J, Veldheer S, Pachas G, Hrabovsky S, Hameed A, Allen SI, Cather C, Azzouz N, Yingst J, Hammett E, Modesto J, Krebs NM, Lester C, Trushin N, Reinhart L, Wasserman E, Zhu J, Liao J, Muscat JE, Richie JP, Evins AE. The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial. PLoS One 2022; 17:e0275522. [PMID: 36322562 PMCID: PMC9629593 DOI: 10.1371/journal.pone.0275522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The U.S. Food and Drug Administration and the government of New Zealand have proposed a reduction of the nicotine content in cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders. METHODS In a randomized controlled parallel group trial conducted at two sites in the USA (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with a current (n = 118) or lifetime (n = 70) anxiety or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned (1:1) to smoke either Usual Nicotine Content (UNC) (11.6 mg nicotine/cigarette) research cigarettes, or Reduced Nicotine Content (RNC) research cigarettes where the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice to either receive assistance to quit smoking, receive free research cigarettes, or resume using their own cigarette brand during a 12-week follow-up period. Main outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior and dependence and severity of psychiatric symptoms. The pre-registered primary outcome was plasma cotinine. RESULTS A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to the lowest nicotine content cigarettes, compared to smokers in the UNC group, at the last randomized visit the RNC group had significantly lower plasma cotinine (metabolite of nicotine): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urine NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon-monoxide, cigarette consumption, and cigarette dependence were also significantly lower in the RNC group than the UNC group. No between-group differences were found on a range of other biomarkers (e.g. 8-isoprostanes) or health indicators (e.g. blood pressure), or on 5 different psychiatric questionnaires, including the Kessler K6 measure of psychological distress. At the end of the subsequent 12-week treatment choice phase, those randomized to the RNC group were more likely to have quit smoking, based on initial intent-to-treat sample, n = 188 (18.1% RNC v 4.3% UNC, p = 0.004). CONCLUSION Reducing nicotine content in cigarettes to very low levels reduces some toxicant exposures and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health. TRIAL REGISTRATION TRN: NCT01928758, registered August 21, 2013.
Collapse
Affiliation(s)
- Jonathan Foulds
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Susan Veldheer
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Shari Hrabovsky
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- Ross and Carol Nese College of Nursing, Penn State University, State College, PA, United States of America
| | - Ahmad Hameed
- Department of Psychiatry, Pennsylvania State University—College of Medicine, Hershey, PA, United States of America
| | - Sophia I. Allen
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Corinne Cather
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Nour Azzouz
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Jessica Yingst
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Erin Hammett
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Jennifer Modesto
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Nicolle M. Krebs
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Courtney Lester
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Neil Trushin
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Lisa Reinhart
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Emily Wasserman
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Junjia Zhu
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Jason Liao
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Joshua E. Muscat
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - John P. Richie
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
4
|
Koshko L, Debarba LK, Sacla M, de Lima JBM, Didyuk O, Fakhoury P, Sadagurski M. In Utero Maternal Benzene Exposure Predisposes to the Metabolic Imbalance in the Offspring. Toxicol Sci 2021; 180:252-261. [PMID: 33502539 DOI: 10.1093/toxsci/kfab010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Environmental chemicals play a significant role in the development of metabolic disorders, especially when exposure occurs early in life. We have recently demonstrated that benzene exposure, at concentrations relevant to cigarette smoke, induces a severe metabolic imbalance in a sex-specific manner affecting male but not female mice. However, the roles of benzene in the development of aberrant metabolic outcomes following gestational exposure, remain largely unexplored. In this study, we exposed pregnant C57BL/6JB dams to benzene at 50 ppm or filtered air for 6 h/day from gestational day 0.5 (GD0.5) through GD21 and studied male and female offspring metabolic phenotypes in their adult life. While no changes in body weight or body composition were observed between groups, 4-month-old male and female offspring exhibited reduced parameters of energy homeostasis (VO2, VCO2, and heat production). However, only male offspring from benzene-exposed dams were glucose intolerant and insulin resistant at this age. By 6 months of age, both male and female offspring exhibited marked glucose intolerance however, only male offspring developed severe insulin resistance. This effect was accompanied by elevated insulin secretion and increased beta-cell mass only in male offspring. In support, Homeostatic Model Assessment for Insulin Resistance, the index of insulin resistance was elevated only in male but not in female offspring. Regardless, both male and female offspring exhibited a considerable increase in hepatic gene expression associated with inflammation and endoplasmic reticulum stress. Thus, gestational benzene exposure can predispose offspring to increased susceptibility to the metabolic imbalance in adulthood with differential sensitivity between sexes.
Collapse
Affiliation(s)
- Lisa Koshko
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| | - Lucas K Debarba
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| | - Mikaela Sacla
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| | - Juliana B M de Lima
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| | - Olesya Didyuk
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| | - Patrick Fakhoury
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| | - Marianna Sadagurski
- Department of Biological Sciences, Integrative Biosciences Center (IBio), Wayne State University, Detroit, Michigan 48202, USA
| |
Collapse
|
5
|
Allen SI, Wasserman E, Veldheer S, Yingst J, Hrabovsky S, Liao J, Krebs NM, Horn K, Reinhart L, Modesto J, Putt K, Evins AE, Muscat JE, Richie JP, Foulds J. Characteristics of Adult Cigarette Smokers Who "Relight" and the Effects of Exposure to Tobacco Smoke Constituents. Nicotine Tob Res 2020; 21:1206-1212. [PMID: 29982710 DOI: 10.1093/ntr/nty138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/29/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION About half of smokers relight their cigarette, a habit that is a risk factor for chronic bronchitis and possibly lung cancer. Little is known about the characteristics of smokers who relight and their dependence on nicotine. It is unknown whether relighting affects exposure to tobacco smoke constituents. This study examined the characteristics of relighters of usual brand cigarettes and whether relighting affects exposure to selected tobacco smoke constituents. METHODS We explored relighting status and frequency, using baseline data from 248 adult smokers participating in studies of reduced nicotine cigarettes in relation to demographic and cigarette characteristics, smoking behaviors, nicotine dependence, biomarkers of exposure (exhaled carbon monoxide, blood cotinine), and biomarkers of oxidative stress (ratio of oxidized/reduced glutathione). RESULTS 69.4% (n = 172) of subjects reported relighting, and they relit an average of five cigarettes out of 20. Both relighters and non-relighters smoked a mean of 20 cigarettes per day (p = .6). Relighting was significantly associated with higher nicotine dependence, use of longer rod cigarettes, older age, lower income, and unemployment. There were no significant associations between relighting and blood cotinine, exhaled carbon monoxide or measures of oxidized/reduced blood glutathione. CONCLUSIONS The majority of subjects were relighters, who had higher levels of nicotine dependence than non-relighters. Relighters had similar levels of plasma cotinine and exhaled carbon monoxide to non-relighters. IMPLICATIONS No study has compared the cigarette characteristics and biomarkers of exposure of adult cigarette smokers who relight with those who do not. Relighting behavior was common in our sample and was associated with low income, not currently working, higher nicotine dependence, cigarette rod length, daily cigarette use years, and a lifetime history of depressed mood.
Collapse
Affiliation(s)
- Sophia I Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jessica Yingst
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Kimberly Horn
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Kayla Putt
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| |
Collapse
|
6
|
Stone E, Marshall H. Electronic cigarettes in physician practice: a complex debate. Intern Med J 2020; 49:438-445. [PMID: 30957372 DOI: 10.1111/imj.14256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/02/2018] [Accepted: 09/28/2018] [Indexed: 12/31/2022]
Abstract
E-cigarettes, or electronic nicotine delivery systems (ENDS), have been suggested as a potential aid for smoking cessation, but many questions about their efficacy and safety remain unanswered. Until very recently, the evidence for ENDS in smoking cessation was largely based on observational studies or randomised controlled trials with methodological flaws and did not provide adequate evidence to support strongly ENDS for smoking cessation. Concerns about the uptake of ENDS by nonsmoking populations (such as adolescents) remain. More recent evidence may indicate the effect of ENDS in smoking cessation, but many questions remain unanswered. In this article, we address recent claims that failure to recommend ENDS for smoking cessation represents unethical practice. We strongly dispute this claim, analysing the many complex issues that clinicians working in smoking cessation should consider.
Collapse
Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Kinghorn Cancer Centre, St Vincent's Hospital Sydney, University of NSW, Sydney, New South Wales, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Song MA, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian C, O'Connor R, Rees VW, Woroszylo C, Shields PG. Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma. J Natl Cancer Inst 2017; 109:3836090. [PMID: 28525914 DOI: 10.1093/jnci/djx075] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/23/2017] [Indexed: 01/09/2023] Open
Abstract
The 2014 Surgeon General's Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from "lighter" smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.
Collapse
Affiliation(s)
- Min-Ae Song
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Neal L Benowitz
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Micah Berman
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Theodore M Brasky
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - K Michael Cummings
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Dorothy K Hatsukami
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Catalin Marian
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Richard O'Connor
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Vaughan W Rees
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Casper Woroszylo
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| | - Peter G Shields
- Affiliations of authors: Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH (MAS, MB, TMB, CM, PGS); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH (MAS, CW); Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics and Center for Tobacco Control Research and Education, University of California, San Francisco, CA (NLB); College of Public Health and Moritz College of Law, The Ohio State University, Columbus, OH (MB); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KMC); Tobacco Research Programs and Department of Psychiatry, University of Minnesota, Minneapolis, MN (DH); Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, (CM); Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (RO); Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA (VWR)
| |
Collapse
|
8
|
Krebs NM, Allen SI, Veldheer S, Martinez DJ, Horn K, Livelsberger C, Modesto J, Kuprewicz R, Wilhelm A, Hrabovsky S, Kazi A, Fazzi A, Liao J, Zhu J, Wasserman E, Reilly SM, Reinhart L, Trushin N, Moyer RE, Bascom R, Foulds J, Richie JP, Muscat JE. Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial. Trials 2017; 18:300. [PMID: 28673312 PMCID: PMC5496140 DOI: 10.1186/s13063-017-2038-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/01/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such as low socioeconomic status (SES) populations. This study aims to evaluate the response to a reduced nicotine intervention in low SES smokers, as defined here as those with less than 16 years of education, by switching smokers from high nicotine commercial cigarettes to RNC cigarettes. METHODS/DESIGN Adults (N = 280) who have smoked five cigarettes or more per day for the past year, have not made a quit attempt in the prior month, are not planning to quit, and have less than 16 years of education are recruited into a two-arm, double-blinded randomized controlled trial. First, participants smoke their usual brand of cigarettes for 1 week and SPECTRUM research cigarettes containing a usual amount of nicotine for 2 weeks. During the experimental phase, participants are randomized to continue smoking SPECTRUM research cigarettes that contain either (1) usual nicotine content (UNC) (11.6 mg/cigarette) or (2) RNC (11.6 to 0.2 mg/cigarette) over 18 weeks. During the final phase of the study, all participants are offered the choice to quit smoking with nicotine replacement therapy, continue smoking the research cigarettes, or return to their usual brand of cigarettes. The primary outcomes of the study include retention rates and compliance with using only research cigarettes and no use of other nicotine-containing products. Secondary outcomes are tobacco smoke biomarkers, nicotine dependence measures, smoking topography, stress levels, and adverse health consequences. DISCUSSION Results from this study will provide information on whether low SES smokers can maintain a course of progressive nicotine reduction without increases in incidence of adverse effects. TRIAL REGISTRATION ClinicalTrials.gov, NCT01928719 . Registered on 21 August 2013.
Collapse
Affiliation(s)
- Nicolle M. Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Sophia I. Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Diane J. Martinez
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Kimberly Horn
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Robin Kuprewicz
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Ashley Wilhelm
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Abid Kazi
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Alyse Fazzi
- Investigational Drug Service, Department of Pharmacy, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Samantha M. Reilly
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Robinn E. Moyer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Rebecca Bascom
- Department of Medicine, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - John P. Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| |
Collapse
|
9
|
Allen SI, Foulds J, Pachas GN, Veldheer S, Cather C, Azzouz N, Hrabovsky S, Hameed A, Yingst J, Hammett E, Modesto J, Krebs NM, Zhu J, Liao J, Muscat JE, Richie J, Evins AE. A two-site, two-arm, 34-week, double-blind, parallel-group, randomized controlled trial of reduced nicotine cigarettes in smokers with mood and/or anxiety disorders: trial design and protocol. BMC Public Health 2017; 17:100. [PMID: 28103841 PMCID: PMC5248523 DOI: 10.1186/s12889-016-3946-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/14/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The U.S. Food and Drug Administration can set standards for cigarettes that could include reducing their nicotine content. Such a standard should improve public health without causing unintended serious consequences for sub-populations. This study evaluates the effect of progressive nicotine reduction in cigarettes on smoking behavior, toxicant exposure, and psychiatric symptoms in smokers with comorbid mood and/or anxiety disorders using a two-site, two-arm, double-blind, parallel group, randomized controlled trial (RCT) in four phases over 34 weeks. METHODS Adult smokers (N = 200) of 5 or more cigarettes per day will be randomized across two sites (Penn State and Massachusetts General). Participants must have not had a quit attempt in the prior month, nor be planning to quit in the next 6 months, meet criteria for a current or lifetime unipolar mood and/or anxiety disorder based on the structured Mini-International Neuropsychiatric Interview, and must not have an unstable medical or psychiatric condition. After a week of smoking their own cigarettes, participants receive two weeks of Spectrum research cigarettes with usual nicotine content (11.6 mg). After this baseline period, participants will be randomly assigned to continue smoking Spectrum research cigarettes that contain either (a) Usual Nicotine Content (11.6 mg); or (b) Reduced Nicotine Content: the nicotine content per cigarette is progressively reduced from approximately 11.6 mg to 0.2 mg in five steps over 18 weeks. At the end of the randomization phase, participants will be offered the choice to either (a) quit smoking with assistance, (b) continue smoking free research cigarettes, or (c) return to purchasing their own cigarettes, for the final 12 weeks of the study. The primary outcome measure is blood cotinine; key secondary outcomes are: exhaled carbon monoxide, urinary total NNAL- 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and 1-hydroxypyrene, oxidative stress biomarkers including 8-isoprostanes, measures of psychiatric symptoms (e.g., depression, anxiety), smoking behavior and dependence (e.g., cigarette consumption, quit attempts), and health effects (e.g., blood pressure, respiratory symptoms). DISCUSSION Results from this study will inform FDA on the potential effects of regulating the nicotine content of cigarettes and help determine whether smokers with mood and/or anxiety disorders can safely transition to significantly reduced nicotine content cigarettes. TRIAL REGISTRATION TRN: NCT01928758 , registered August 21, 2013.
Collapse
Affiliation(s)
- Sophia I. Allen
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Gladys N. Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Susan Veldheer
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Corinne Cather
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Nour Azzouz
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Ahmad Hameed
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Jessica Yingst
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Erin Hammett
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jennifer Modesto
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Nicolle M. Krebs
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Junjia Zhu
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jason Liao
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Joshua E. Muscat
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - John Richie
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| |
Collapse
|
10
|
Mercincavage M, Souprountchouk V, Tang KZ, Dumont RL, Wileyto EP, Carmella SG, Hecht SS, Strasser AA. A Randomized Controlled Trial of Progressively Reduced Nicotine Content Cigarettes on Smoking Behaviors, Biomarkers of Exposure, and Subjective Ratings. Cancer Epidemiol Biomarkers Prev 2016; 25:1125-33. [PMID: 27197288 DOI: 10.1158/1055-9965.epi-15-1088] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/18/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The U.S. FDA has the authority to reduce cigarette nicotine content if found to benefit public health. Reduced nicotine content (RNC) cigarette use does not appear to increase harm exposure, but studies have not rigorously assessed smoking behavior or used a comprehensive panel of biomarkers. This study examined the effects of progressively decreasing RNC cigarettes on smoking behaviors, biomarkers of exposure, and subjective ratings. METHODS One hundred and fifty-eight daily, non-treatment-seeking smokers participated in a 35-day randomized, unblinded, parallel study. After a 5-day baseline period, participants were randomly assigned to an experimental group (n = 80) that smoked progressively decreasing RNC cigarettes during three 10-day periods, or control group (n = 78) that smoked their own brand throughout the study. RESULTS Daily cigarette consumption significantly increased for the intermediate RNCs (P's < 0.001) but approached baseline rate for the lowest RNC (P = 0.686); in contrast, puffing behavior significantly decreased at intermediate levels and increased for the lowest RNC (P's < 0.001). Cotinine and NNAL significantly decreased by RNC period (P's ≤ 0.001-0.02), whereas CO boost initially increased (P's = 0.001-0.005). 1-HOP did not change by period (P = 0.109). CONCLUSIONS Smoking behaviors changed by RNC period via CPD and puffing behavior. Biomarkers of exposure generally decreased with nicotine content. IMPACT Findings suggest that RNC use does not ubiquitously reduce smoking behaviors or biomarkers, yet the lowest RNC level tested may reduce harm exposure. This emphasizes the importance of using multiple behavioral and biologic measures to address the impact of RNC cigarette smoking. Cancer Epidemiol Biomarkers Prev; 25(7); 1125-33. ©2016 AACR.
Collapse
Affiliation(s)
- Melissa Mercincavage
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Valentina Souprountchouk
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kathy Z Tang
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rachel L Dumont
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - E Paul Wileyto
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Andrew A Strasser
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| |
Collapse
|
11
|
Hu CW, Hsu YW, Chen JL, Tam LM, Chao MR. Direct analysis of tobacco-specific nitrosamine NNK and its metabolite NNAL in human urine by LC-MS/MS: evidence of linkage to methylated DNA lesions. Arch Toxicol 2013; 88:291-9. [PMID: 24057573 DOI: 10.1007/s00204-013-1137-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/12/2013] [Indexed: 12/22/2022]
Abstract
4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and its urinary metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), are the most investigated carcinogenic biomarkers of tobacco-specific nitrosamines. Here, we report the development of a sensitive and selective assay based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) to simultaneously measure urinary NNK and NNAL. With the use of isotope internal standards and online solid-phase extraction, urine samples were directly analyzed without prior sample purification. The detection limits of this method were 0.13 and 0.19 pg on column for NNK and NNAL, respectively. Inter- and intra-day imprecision was <10 %. Mean recovery of NNK and NNAL in urine was 99-100 %. This method was applied to measure urinary NNK and NNAL in 101 smokers and 40 nonsmokers to assess tobacco exposure. Urinary nicotine, cotinine, N3-methyladenine (N3-MeA), and N7-methylguanine (N7-MeG) were also measured by isotope-dilution LC-MS/MS methods. The results showed that urinary NNK was not observed in all smokers. Urinary free NNAL (0.10 ± 0.09 ng/mg creatinine) and total NNAL (0.17 ± 0.14 ng/mg creatinine) were detected in all smokers. Urinary concentrations of NNAL were significantly correlated with nicotine, cotinine, N3-MeA, and N7-MeG in smokers (P < 0.001). This method enables the direct and simultaneous measurement of NNK and NNAL in urine using only 50 μL of urine. This study first demonstrated in human that urinary tobacco-specific nitrosamines metabolite (NNAL) are highly correlated with their resulting methylated DNA lesions in urine, which may help to substantiate an increased cancer risk associated with tobacco smoke exposure.
Collapse
Affiliation(s)
- Chiung-Wen Hu
- Department of Public Health, Chung Shan Medical University, Taichung, 402, Taiwan
| | | | | | | | | |
Collapse
|
12
|
Teeguarden JG, Housand CJ, Smith JN, Hinderliter PM, Gunawan R, Timchalk CA. A multi-route model of nicotine-cotinine pharmacokinetics, pharmacodynamics and brain nicotinic acetylcholine receptor binding in humans. Regul Toxicol Pharmacol 2012; 65:12-28. [PMID: 23099439 DOI: 10.1016/j.yrtph.2012.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 02/04/2023]
Abstract
The pharmacokinetics of nicotine, the pharmacologically active alkaloid in tobacco responsible for addiction, are well characterized in humans. We developed a physiologically based pharmacokinetic/pharmacodynamic model of nicotine pharmacokinetics, brain dosimetry and brain nicotinic acetylcholine receptor (nAChRs) occupancy. A Bayesian framework was applied to optimize model parameters against multiple human data sets. The resulting model was consistent with both calibration and test data sets, but in general underestimated variability. A pharmacodynamic model relating nicotine levels to increases in heart rate as a proxy for the pharmacological effects of nicotine accurately described the nicotine related changes in heart rate and the development and decay of tolerance to nicotine. The PBPK model was utilized to quantitatively capture the combined impact of variation in physiological and metabolic parameters, nicotine availability and smoking compensation on the change in number of cigarettes smoked and toxicant exposure in a population of 10,000 people presented with a reduced toxicant (50%), reduced nicotine (50%) cigarette Across the population, toxicant exposure is reduced in some but not all smokers. Reductions are not in proportion to reductions in toxicant yields, largely due to partial compensation in response to reduced nicotine yields. This framework can be used as a key element of a dosimetry-driven risk assessment strategy for cigarette smoke constituents.
Collapse
Affiliation(s)
- Justin G Teeguarden
- Battelle, Pacific Northwest Division, 902 Battelle Blvd., Richland, WA 99352, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Nilsson R. The molecular basis for induction of human cancers by tobacco specific nitrosamines. Regul Toxicol Pharmacol 2011; 60:268-80. [DOI: 10.1016/j.yrtph.2011.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/24/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
|
14
|
O'Connor RJ, Rees VW, Norton KJ, Cummings KM, Connolly GN, Alpert HR, Sjödin A, Romanoff L, Li Z, June KM, Giovino GA. Does switching to reduced ignition propensity cigarettes alter smoking behavior or exposure to tobacco smoke constituents? Nicotine Tob Res 2010; 12:1011-8. [PMID: 20805292 DOI: 10.1093/ntr/ntq139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Since 2004, several jurisdictions have mandated that cigarettes show reduced ignition propensity (RIP) in laboratory testing. RIP cigarettes may limit fires caused by smoldering cigarettes, reducing fire-related deaths and injury. However, some evidence suggests that RIP cigarettes emit more carbon monoxide and polycyclic aromatic hydrocarbons, and smokers may alter their smoking patterns in response to RIP cigarettes. Both of these could increase smokers' exposures to harmful constituents in cigarettes. METHODS An 18-day switching study with a comparison group was conducted in Boston, MA (N = 77), and Buffalo, NY (N = 83), in 2006-2007. Current daily smokers completed 4 laboratory visits and two 48-hr field data collections. After a 4-day baseline, Boston participants switched to RIP cigarettes for 14 days, whereas Buffalo participants smoked RIP cigarettes throughout. Outcome measures included cigarettes smoked per day; smoking topography; salivary cotinine; breath CO; and hydroxylated metabolites of pyrene, naphthalene, phenanthrene, and fluorene. Because the groups differed demographically, analyses adjusted for race, age, and sex. RESULTS We observed no significant changes in smoking topography or CO exposure among participants who switched to RIP cigarettes. Cigarette use decreased significantly in the switched group (37.7 cigarettes/48 hr vs. 32.6 cigarettes/48 hr, p = .031), while hydroxyphenanthrenes increased significantly (555 ng/g creatinine vs. 669 ng/g creatinine, p = .007). No other biomarkers were significantly affected. DISCUSSION Small increases in exposure to phenanthrene among smokers who switched to RIP versions were observed, while other exposures and smoking topography were not significantly affected. Toxicological implications of these findings are unclear. These findings should be weighed against the potential public health benefits of adopting RIP design standards for cigarette products.
Collapse
Affiliation(s)
- Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Marian C, O'Connor RJ, Djordjevic M, Rees VW, Hatsukami DK, Shields PG. Reconciling human smoking behavior and machine smoking patterns: implications for understanding smoking behavior and the impact on laboratory studies. Cancer Epidemiol Biomarkers Prev 2009; 18:3305-20. [PMID: 19959678 PMCID: PMC2789355 DOI: 10.1158/1055-9965.epi-09-1014] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent Food and Drug Administration legislation enables the mandating of product performance standards for cigarette smoke and the evaluation of manufacturers' health claims for modified tobacco products. Laboratory studies used for these evaluations and also for understanding tobacco smoke toxicology use machines to generate smoke. The goal of this review is to critically evaluate methods to assess human smoking behavior and replicate this in the laboratory. METHODS Smoking behavior and smoking machine studies were identified using PubMed and publicly available databases for internal tobacco company documents. RESULTS The smoking machine was developed to generate smoke to allow for comparing cigarette tar and nicotine yields. The intent was to infer relative human disease risk, but this concept was flawed because humans tailor their smoking to the product, and chemical yields and toxicologic effects change with different smoking profiles. Although smoking machines also allow for mechanistic assessments of smoking-related diseases, the interpretations also are limited. However, available methods to assess how humans puff could be used to provide better laboratory assessments, but these need to be validated. Separately, the contribution of smoke mouth-holding and inhalation to dose need to be assessed, because these parts of smoking are not captured by the smoking machine. Better comparisons of cigarettes might be done by tailoring human puff profiles to the product based on human studies and comparing results across regimens. CONCLUSIONS There are major research gaps that limit the use of smoking machine studies for informing tobacco control regulation and mechanistic studies.
Collapse
Affiliation(s)
- Catalin Marian
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Cancer, Washington, DC 20057
| | - Richard J. O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263
| | - Mirjana Djordjevic
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892
| | - Vaughan W. Rees
- Division of Public Health Practice, Harvard School of Public Health, Boston, MA
| | - Dorothy K. Hatsukami
- University of Minnesota Transdisciplinary Tobacco Use Research Center, Minneapolis, MN 55414, USA
| | - Peter G. Shields
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Cancer, Washington, DC 20057
| |
Collapse
|
16
|
Ghosh D, Mishra MK, Das S, Kaushik DK, Basu A. Tobacco carcinogen induces microglial activation and subsequent neuronal damage. J Neurochem 2009; 110:1070-81. [PMID: 19500213 DOI: 10.1111/j.1471-4159.2009.06203.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
4-Methylnitrosamino-1-(3-pyridyl)-1-butanone (NNK) is a tobacco-specific procarcinogen. We have investigated whether NNK causes inflammatory upheaval in the brain by activation of resident microglia and astrocyte and result in bystander neuronal damage. We have carried out the work in both in vitro and in vivo models. We have found that treatment with NNK causes significant activation of mouse microglial (BV2) cell line as evident by increase in reactive oxygen species and nitric oxide level. Western blot analysis has showed increase in proinflammatory signaling proteins, proinflammatory effector proteins, and other stress-related proteins. Interestingly, increased levels of proinflammatory cytokines like interleukin (IL)-6, tumor necrosis factor-alpha, monocyte chemoattractant protein 1 (MCP1), and IL-12p70 are also detected. Work from our in vivo studies has demonstrated similar increase in proinflammatory signaling and effector molecules along with the proinflammatory cytokine levels, following NNK treatment. Immunohistochemical staining of the brain sections of NNK-treated mice reveals massive microglial and astrocyte activation along with distinct foci of neuronal damage. Both in vitro and in vivo results provide strong indication that NNK causes significant upheaval of the inflammatory condition of brain and inflicts subsequent neuronal damage.
Collapse
|
17
|
Seeman JI, Carchman RA. The possible role of ammonia toxicity on the exposure, deposition, retention, and the bioavailability of nicotine during smoking. Food Chem Toxicol 2008; 46:1863-81. [PMID: 18450355 DOI: 10.1016/j.fct.2008.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 02/18/2008] [Accepted: 02/20/2008] [Indexed: 11/26/2022]
Abstract
A complete and rigorous review is presented of the possible effect(s) of ammonia on the exposure, deposition and retention of nicotine during smoking and the bioavailability of nicotine to the smoker. There are no toxicological data in humans regarding ammonia exposure within the context of tobacco smoke. Extrapolation from occupational exposure of ammonia to smoking in humans suggests minimal, non-toxicological effects, if any. No direct study has examined the effect of the ammonia on the total rate or amount of nicotine reaching the arterial bloodstream or brains of smokers. Machine-smoking methods have been reported which accurately quantify >99% of the nicotine in mainstream (MS) smoke for a wide variety of commercial and test cigarettes, including a series of experimental cigarettes having a range in MS smoke ammonia yields using the US Federal Trade Commission (FTC) protocol. However, the actual exposure of nicotine to smokers depends on their own smoking behavior. The nicotine ring system is relatively thermally stable. Protonated nicotine forms nicotine which evaporates before the nicotine ring system decomposes. The experimental data indicate that neither nicotine transfer from tobacco to MS smoke nor nicotine bioavailability to the smoker increases with an increase in any of the following properties: tobacco soluble ammonia, MS smoke ammonia, "tobacco pH" or "smoke pH" at levels found in commercial cigarettes. Gas phase nicotine deposits primarily in the mouth and upper respiratory tract. To the extent that ammonia increases the deposition of nicotine in the buccal cavity and upper respiratory tract during smoking, the total rate and amount of nicotine into the arterial bloodstream and to the central nervous system will decrease. Charged nicotine analogues are actively transported in a number of tissues. This active transport system appears to be insensitive to pH and the form of nicotine in the biological milieu, suggesting that protonated nicotine may be a substrate for active transport. Neither "smoke pH" of commercial cigarettes nor "smoke pHeff" nor the fraction of non-protonated nicotine in tobacco smoke particulate matter are useful, practical smoke parameters for providing understanding or predictability of nicotine bioavailability to smokers. Greater than 95% of both ammonia and nicotine are in the gas phase of environmental tobacco, and both are likely to deposit in the buccal cavity and upper respiratory tract following exposure.
Collapse
Affiliation(s)
- Jeffrey I Seeman
- SaddlePoint Frontiers, 12001 Bollingbrook Place, Richmond, VA 23236-3218, United States.
| | | |
Collapse
|
18
|
DeMarini DM, Gudi R, Szkudlinska A, Rao M, Recio L, Kehl M, Kirby PE, Polzin G, Richter PA. Genotoxicity of 10 cigarette smoke condensates in four test systems: comparisons between assays and condensates. Mutat Res 2008; 650:15-29. [PMID: 18006367 DOI: 10.1016/j.mrgentox.2007.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/21/2007] [Accepted: 09/25/2007] [Indexed: 11/20/2022]
Abstract
The particulate fraction of cigarette smoke, cigarette smoke condensate (CSC), is genotoxic in many short-term in vitro tests and is carcinogenic in rodents. However, no study has evaluated a series of CSCs prepared from a diverse set of cigarettes and produced with different smoking machine regimens in several short-term genotoxicity tests. Here we report on the genotoxicity of 10 CSCs prepared from commercial cigarettes that ranged from ultra-low tar per cigarette (< or =6.5 mg) to full flavor (>14.5 mg) as determined by the Federal Trade Commission (FTC) smoking regimen, a reference cigarette blended to be representative of a U.S. FTC-regimen low-tar cigarette, and experimental cigarettes constructed of single tobacco types. CSCs were tested in the presence of rat liver S9 in the Salmonella plate-incorporation assay using frameshift strains TA98 and YG1041; in micronucleus and comet assays in L5178Y/Tk(+/-) 7.3.2C mouse lymphoma cells, and in CHO-K(1) cells for chromosome aberrations. All 10 CSCs were mutagenic in both strains of Salmonella, and the rank order of their mutagenic potencies was similar. Their mutagenic potencies in Salmonella spanned 7-fold when expressed as rev/mug CSC but 158-fold when expressed as rev/mg nicotine; the range of genotoxic potencies of the CSCs in the other assays was similar regardless of how the data were expressed. All 10 CSCs induced micronuclei with a 3-fold range in their potency. All but one CSC induced DNA damage over a 20-fold range, and all but one CSC induced chromosome aberrations over a 4-fold range. There was no relation among the genotoxic potencies of the CSCs across the assays, and a qualitative advantage of the addition of the other assays to the Salmonella assay was not supported by our findings. Although consideration of nicotine levels may improve the relevance of the quantitative data obtained in the Salmonella and possibly comet assays, compensatory smoking habits and other factors may make the data from the assays used here have qualitative but not quantitative value in assessing risk of cigarette types and cigarette smoking to human health.
Collapse
Affiliation(s)
- David M DeMarini
- Environmental Carcinogenesis Division, US Environmental Protection Agency, Research Triangle Park, NC 27711, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Hatsukami DK, Le CT, Zhang Y, Joseph AM, Mooney ME, Carmella SG, Hecht SS. Toxicant exposure in cigarette reducers versus light smokers. Cancer Epidemiol Biomarkers Prev 2007; 15:2355-8. [PMID: 17164356 PMCID: PMC6512339 DOI: 10.1158/1055-9965.epi-06-0240] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The extent of exposure to tobacco toxicants in smokers who have reduced their cigarette intake compared with smokers who are light smokers is relatively unknown. The goal of this study is to investigate the occurrence of compensatory smoking in reducers compared with light smokers by measuring toxicant exposure. METHODS Participants in two smoking reduction intervention studies (N = 64) were selected for comparison with a group of light smokers (N = 62) who smoked the same number of cigarettes as the reducers. A compensatory smoking score was defined (biomarker level for reducer/biomarker level for light smoker) and calculated for urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides (total NNAL), metabolites of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-I-(3-pyridyl)-1-butanone, to measure the degree of smoking compensation in reducers when compared with the light smokers. RESULTS The mean level of creatinine-adjusted total NNAL for reducers was over twice that of light smokers even when they smoked about the same number of cigarettes per day. The difference of the mean total NNAL concentrations between light smokers and reducers was highly significant (P < 0.0001). Wide variability in total NNAL concentrations was also observed in reducers, with the extent of this variability between light smokers and reducers being significantly different (P = 0.0005). The level of individual reduction was shown to be a consistent predictor of compensatory smoking (r = 0.50; adjusted Ps = 0.002), with greater cigarette reduction associated with more compensation. CONCLUSIONS Compensatory smoking limits the harm reduction value of decreased smoking of cigarettes.
Collapse
Affiliation(s)
- Dorothy K Hatsukami
- Tobacco Use Research Center, University of Minnesota, 2701 University Avenue Southeast, #201, Minneapolis, MN 55414, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Strasser AA, O'Connor RJ, Mooney ME, Wileyto EP. Digital image analysis of cigarette filter stains as an indicator of compensatory smoking. Cancer Epidemiol Biomarkers Prev 2006; 15:2565-9. [PMID: 17164388 DOI: 10.1158/1055-9965.epi-06-0623] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Cigarette filters trap a significant portion of carcinogen-containing smoke particulate and may provide an indication of cigarette constituent exposure. A technique for quantifying filter tar staining with digital imaging has shown predictive value between typical total puff volume and filter tar stain intensity. The current study uses smoking topography data acquired during an examination of compensatory smoking of Quest cigarettes and digital analyses of the tar stains of the spent Quest cigarette filters. Due to reduced nicotine levels, we hypothesized compensatory smoking to occur. The purposes of the current study were to describe the physical characteristics of the Quest cigarettes, to further validate the effect of puff volume on filter tar staining, and to examine the effect of compensatory smoking on changes in filter tar staining, hypothesizing that compensatory smoking would result in more intense tar staining. METHODS Physical characteristics of the Quest cigarettes were measured to characterize the product. Spent cigarette filters were digitally analyzed for color intensity features, matched to smoking topography measures, and examined in regression models. Difference scores for digital imaging and smoking topography were used in a regression model to identify the effect of compensatory smoking on tar stain. RESULTS Total puff volume was a significant predictor of a*center (redness) [beta = 0.003 (SE, 0.0004), R2 = 0.42, t = 7.87, P < 0.001] and L*center (lightness) [beta = -0.015 (SE, 0.002), R2 = 0.45, t = -8.18, P < 0.001] for Quest cigarettes and a significant predictor of a*center [beta = 0.003 (SE, 0.0005), R2 = 0.37, t = 5.27, P < 0.001] and L*center [beta = -0.009 (SE, 0.002), R2 = 0.35, t = -5.05, P < 0.001] for own preferred brand. Regression models indicate total puff volume difference was a significant predictor of L*center difference [beta = -0.01 (SE, 0.003), R2 = 0.171, t = -3.15, P = 0.003] and approached significance for a*center difference [beta = 0.002 (SE, 0.001), R2 = 0.057, t = 1.99, P = 0.053]. CONCLUSION Results suggest that compensatory smoking may be detectable by darkening and reddening of the tar stain. This type of measure could be useful in quantifying the extent to which human smokers smoke differently than standard testing protocols and in assessing the prevalence of compensatory smoking in population samples.
Collapse
Affiliation(s)
- Andrew A Strasser
- Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104-3309, USA.
| | | | | | | |
Collapse
|
21
|
O'Connor RJ, Giovino GA, Kozlowski LT, Shiffman S, Hyland A, Bernert JT, Caraballo RS, Cummings KM. Changes in nicotine intake and cigarette use over time in two nationally representative cross-sectional samples of smokers. Am J Epidemiol 2006; 164:750-9. [PMID: 16887891 DOI: 10.1093/aje/kwj263] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Population surveys have observed decreases in cigarette use over time among smokers. These decreases have probably been influenced by tobacco control measures implemented over the past several decades, but few data exist on whether smokers have also reduced their nicotine intake. The authors examined data from two cross-sectional National Health and Nutrition Examination Surveys (NHANES), conducted in 1988-1994 and 1999-2002. Laboratory, examination, and interview data from current smokers not reporting nicotine intake from other sources were examined. From NHANES III (1988-1994) to NHANES 1999-2002, the average number of cigarettes smoked per day (CPD) fell by nearly 15% (three cigarettes), while the mean serum cotinine level fell by 13% (30 ng/ml). Finer breakdowns of CPD data in each time period suggested that most of the change occurred in the lower (<10 CPD) and higher (>or=20 CPD) smoking categories. These data suggest that CPD may represent a proxy for exposure to nicotine and perhaps other tobacco smoke constituents on the population level, since the decline in serum cotinine levels observed among smokers closely paralleled the decline in self-reported CPD between 1988-1994 and 1999-2002. In addition, these data are inconsistent with the hypothesis that the remaining population of smokers is becoming more dependent on nicotine over time.
Collapse
Affiliation(s)
- Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Nilsson R. De minimus non curat lex--virtual thresholds for cancer initiation by tobacco specific nitrosamines--prospects for harm reduction by smokeless tobacco. Int J Occup Med Environ Health 2006; 19:6-35. [PMID: 16881596 DOI: 10.2478/v10001-006-0004-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Whereas the impact of tobacco specific nitrosamines in smokers is obscured by the presence of numerous other carcinogens and promoters, for smokeless tobacco virtually all the carcinogenic potential is associated with 4-(nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK) and N'-nitrosonornicotine (NNN). In some countries exposure to smokeless tobacco with extremely high nitrosamine concentrations have been found to induce cancers in the head-neck region, whereas three recent large epidemiological studies failed to detect any such risk with respect to Swedish low-nitrosamine snuff. This review deals with quantitative aspects of DNA adduct formation from NNN and NNK in relation to the background levels ubiquitously found in healthy humans without known exposures to either tobacco or alkylating agents. The lack of significant increases of pro-mutagenic O6-methylations and DNA pyridyloxobutylations seen in smokers, as well as the negative outcome of the Swedish epidemiological studies, can be expected on basis of extrapolation of the dose response relationships found in rodents to actual exposures to NNK and NNN in Swedish snuff or from smoking. Sweden has the lowest prevalence of male smokers and smoking related diseases in the Western World, which has been ascribed to the fact that more than 20% of the grown up male population uses snuff. Smokeless tobacco represents an inexpensive and effective alternative to nicotine delivering products like nicotine patch, spray or gum. Considering that all other tobacco products are freely marketed, the ban on low-nitrosamine snuff in all countries in EU except Sweden is difficult to defend on either medical or ethical grounds.
Collapse
Affiliation(s)
- Robert Nilsson
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, Lódź, Poland.
| |
Collapse
|
23
|
Benowitz NL, Jacob P, Bernert JT, Wilson M, Wang L, Allen F, Dempsey D. Carcinogen exposure during short-term switching from regular to "light" cigarettes. Cancer Epidemiol Biomarkers Prev 2005; 14:1376-83. [PMID: 15941944 DOI: 10.1158/1055-9965.epi-04-0667] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES "Light" cigarettes are extremely popular and are perceived by many smokers as less hazardous than higher-yield cigarettes. The objectives of this study were (a) to assess a battery of biomarkers of tobacco smoke exposure that includes tobacco smoke carcinogens, (b) to examine the behavioral nature of compensation, and (c) to examine the consistency of an individual's tobacco smoke exposure when smoking the same cigarette at different times. METHODS The study was a 3-week crossover study in which smokers smoked their usual cigarettes during weeks 1 and 3, and a light cigarette, with a machine-determined nicotine yield of about 50% of the usual cigarette, during week 2. Blood and urine biomarkers of exposure and subjective questionnaires were collected weekly. RESULTS Based on cotinine and carboxyhemoglobin levels, compensation averaged 78% and 83%, respectively. Urinary excretion of 4-(methylnitrosamino)-1-(3-pyridyl)-butanol, a metabolite of the tobacco specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-butanone, and a number of polycyclic aromatic hydrocarbon metabolites was similar in all conditions. Compensation was accomplished both by smoking cigarettes more intensively and by smoking more cigarettes per day. Exposures to various tobacco smoke constituents while smoking the usual brand of cigarette in weeks 1 and 3 were highly correlated. CONCLUSION Our findings support the idea that smokers compensate to a high degree when switched from their usual brand to a light cigarette. Short-term switching resulted in no significant reduction in carcinogen exposure. Our assessment, based on measures of biochemical exposures, supports the idea that switching to light cigarettes is unlikely to reduce the health risks of cigarette smoking.
Collapse
Affiliation(s)
- Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California at San Francisco, Box 1220, San Francisco, CA 94143-1220, USA.
| | | | | | | | | | | | | |
Collapse
|