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Chido-Amajuoyi OG, Mantey DS, Igbinomwanhia E, Omega-Njemnobi O, Onyeaka H, Yu RK, Agaku I, Shete S. Perceptions of the Addictiveness of Low-Nicotine Cigarettes Versus Typical Cigarettes and Exposure to Tobacco Industry-Sponsored Corrective Campaign. Subst Use Misuse 2024:1-8. [PMID: 38831538 DOI: 10.1080/10826084.2024.2360100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND In 2017, the U.S. Food and Drug Administration (FDA) announced a regulatory plan to reduce the nicotine content of cigarettes. This study examines the association of exposure to industry-sponsored corrective statements on perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes within the general US population. METHODS The study comprised 4975 US adult respondents of the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3). Multinomial logistic regression models were used to examine associations between exposure to tobacco industry corrective messages and perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes. RESULTS In the overall population, 4.1% reported that low-nicotine cigarettes were much more addictive than typical cigarettes, 67.5% said they were equally addictive, while 28.4% reported they were slightly/much less addictive. Adults exposed to industry-sponsored corrective messages had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR 1.57; 95% CI, 1.13-2.19) than those who saw no corrective messages. Those exposed to the corrective messages specifically about the addictiveness of smoking and nicotine had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR, 1.73; 95% CI, 1.07-2.81) compared to those who saw no corrective message. CONCLUSIONS Our findings suggest that exposure to court-ordered tobacco industry corrective statements may have reinforced perceptions on the addictive potential of nicotine. However, study findings indicate a need for campaigns specifically tailored to address misperceptions observed in this study.
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Affiliation(s)
| | - Dale S Mantey
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, TX, USA
| | - Efehi Igbinomwanhia
- Department of Cardiology, Case Western Reserve University/Metrohealth, Cleveland, OH, USA
| | - Onyinye Omega-Njemnobi
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, TX, USA
| | - Henry Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Robert K Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas Maryland Anderson Cancer Center, Houston, TX, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sutfin EL, Lazard AJ, Wagoner KG, King JL, Ross JC, Wiseman KD, Orlan EN, Suerken CK, Reboussin DM, Wolfson M, Noar SM, Reboussin BA. The Development and Testing of a Point-of-Sale E-Cigarette Health Communication Campaign. HEALTH COMMUNICATION 2023:1-12. [PMID: 37937858 PMCID: PMC11113426 DOI: 10.1080/10410236.2023.2265648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Adolescents and young adults continue to use e-cigarettes, and communication campaigns are needed to decrease use among these populations. We developed and tested a point-of-sale communication campaign focused on e-cigarette chemical exposure. We developed messages based on formative research and tested them (versus text-only messages) in a nationally-representative online survey among adolescents and young adults (16-25) (Phase 1). Based on survey findings, we selected a message focused on nicotine and brain development for the point-of-sale trial (Phase 2). We then conducted a cluster-randomized trial at six gas stations with convenience stores, randomly assigned to the intervention (messages displayed) or no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 participants (ages 16-25) per store, at baseline and a four-week follow-up. Phase 1 included 1,636 participants in the online study. Intervention messages were rated as more attention grabbing than plain text messages (p < .05), though were rated similarly on other outcomes. Exposure to intervention messages resulted in larger changes from pre- to posttest for beliefs about addiction and relative harms versus cigarettes (p < .05). Phase 2 included 586 participants in the point-of-sale study. Real-world campaign exposure was low (31.8%), and no differences were found between conditions. E-cigarette prevention messages focused on nicotine's impact on brain development show promise. However, garnering attention for communication campaigns in saturated point-of-sale environments, often dominated by tobacco advertising, is challenging. Future efforts should utilize additional communication channels to directly target adolescents and young adults.
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Affiliation(s)
- Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
| | - Allison J. Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Kimberly G. Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
| | - Jessica L. King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, U.T., United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
| | - Elizabeth N. Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California at Riverside, Riverside, C.A., United States
| | - Seth M. Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, N.C., United States
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Deng C, Wolf JM, Vock DM, Carroll DM, Boatman JA, Hatsukami DK, Leng N, Koopmeiners JS. Practical guidance on modeling choices for the virtual twins method. J Biopharm Stat 2023; 33:653-676. [PMID: 36876989 PMCID: PMC10480344 DOI: 10.1080/10543406.2023.2170404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/30/2022] [Indexed: 03/07/2023]
Abstract
Individuals can vary drastically in their response to the same treatment, and this heterogeneity has driven the push for more personalized medicine. Accurate and interpretable methods to identify subgroups that respond to the treatment differently from the population average are necessary to achieving this goal. The Virtual Twins (VT) method is a highly cited and implemented method for subgroup identification because of its intuitive framework. However, since its initial publication, many researchers still rely heavily on the authors' initial modeling suggestions without examining newer and more powerful alternatives. This leaves much of the potential of the method untapped. We comprehensively evaluate the performance of VT with different combinations of methods in each of its component steps, under a collection of linear and nonlinear problem settings. Our simulations show that the method choice for Step 1 of VT, in which dense models with high predictive performance are fit for the potential outcomes, is highly influential in the overall accuracy of the method, and Superlearner is a promising choice. We illustrate our findings by using VT to identify subgroups with heterogeneous treatment effects in a randomized, double-blind trial of very low nicotine content cigarettes.
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Affiliation(s)
- Chuyu Deng
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jack M. Wolf
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - David M. Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Dana M. Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jeffrey A. Boatman
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Dorothy K. Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ning Leng
- Genentech, San Francisco, CA 94080, USA
| | - Joseph S. Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
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Perkins KA. Acute nicotine reinforcement requires ability to discriminate the stimulus effects of nicotine. Exp Clin Psychopharmacol 2022; 30:253-268. [PMID: 33119384 PMCID: PMC8406437 DOI: 10.1037/pha0000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review of research on behavioral discrimination of nicotine and how it informs public health policy for reducing risk of tobacco dependence is adapted from Kenneth A. Perkins's American Psychological Association Division 28 (Psychopharmacology and Substance Abuse) 2020 Med Associates Brady/Schuster Award Lecture. The author's initial programmatic clinical research on nicotine is introduced, especially efforts to develop and validate a novel method of acute nicotine dosing. After the public health rationale for characterizing the discriminative stimulus effects of nicotine in humans are described, details from two separate programs of research on nicotine discrimination in humans are presented. The first, conducted with nicotine dosing by nasal spray, documented that humans could discriminate nicotine administered rapidly, examined nicotine's neuropharmacological specificity, identified discrimination threshold dose in smokers and nonsmokers, and explored other conditions that might alter ability to discriminate its effects. The second, more recent program focused on threshold doses for discrimination of nicotine by cigarette smoking, a program that was very difficult to do until the past decade, and how nicotine's self-reported "reward" and preference via choice behavior relate to its discriminability. Differences due to menthol and degree of tobacco dependence were also examined. For each of these two programs, the main findings of selected studies are noted, followed by very recent work on nicotine discrimination and choice that informs Food and Drug Administration's efforts to formulate public policy to improve health and reduce the nearly half million American deaths per year due to persistent tobacco use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Li Q, Chen X, Li X, Gorowska M, Li Z, Li Y. The Effects of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Smoking Behavior: An Ecological Momentary Assessment Study. Front Psychiatry 2022; 13:884605. [PMID: 35633808 PMCID: PMC9130591 DOI: 10.3389/fpsyt.2022.884605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, much research has examined the effects of various interventions and treatments for smoking cessation. The results suggest that interventions targeting changes of nicotine content can help smokers reduce tobacco use or quit smoking. A number of clinical studies show that smokers who received an immediate reduction in nicotine content to very low levels have significantly greater reductions in the number of cigarettes smoked and toxic substance exposure compared to those with gradual reductions. However, from the perspective of smoking craving, whether the immediate and gradual reduction in nicotine content reduce smoking by reducing cravings needs further investigation. METHODS 74 eligible Participants were randomly allocated to one of the two experimental conditions: (1) immediate reduction to 0.1 mg of nicotine per cigarette (n = 40); (2) gradual reduction from 1.0 (0.8 g ~ 1.2 mg) to 0.1 mg of nicotine per cigarette (n = 34). All participants completed 1-week baseline period during which they smoked their usual cigarette, followed by 16-week of interventions. The primary outcomes included cigarette cravings and number of cigarettes smoked per day (CPD); secondary outcomes included the number of cigarette-free day and emotional states. RESULTS Among the 52 participants [51 (98.1%) men; mean (SD) age, 33.44 (6.71) years; mean (SD) CPD, 16.83 (9.94)] who completed the trial, significantly lower cravings for cigarettes were observed in the immediate (n = 25) vs. gradual nicotine reduction group (n = 27) in the morning (t = -2.072, p = 0.039) and after dinner (t = -2.056, p = 0.041). Compared with the baseline daily smoking, the number of cigarettes smoked per day was significantly reduced at the beginning of week 12 in the immediate nicotine reduction group (p = 0.001) and at week 16 in the gradual nicotine reduction group (p < 0.001). The number of participants with any cigarette-free day was not significantly different between the groups (p = 0.198). The number of cigarette-free days was significantly more in the immediate vs. gradual nicotine reduction group (p = 0.027). CONCLUSIONS The significantly lower cravings were observed in the immediate vs. gradual nicotine reduction group, and led to faster reduction in the number of CPD, and a significant increase in the number of cigarette-free days. These findings add to the evidence base for reduced nicotine content in cigarettes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: ChiCTR2100048216.
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Affiliation(s)
- Qianling Li
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xijing Chen
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Xiuli Li
- YiDu Central Hospital of Weifang, Weifang, China
| | - Monika Gorowska
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zimin Li
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yonghui Li
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Conceptual model for the evaluation of attractiveness, addictiveness and toxicity of tobacco and related products: The example of JUUL e-cigarettes. Regul Toxicol Pharmacol 2021; 127:105077. [PMID: 34748878 DOI: 10.1016/j.yrtph.2021.105077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/06/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022]
Abstract
Many new tobacco and related products (nTRP) have emerged on the market, with unknown health risks. Here, we present a conceptual model containing the factors and relations between them that contribute to the nTRP's health effects. Factors that determine attractiveness, addictiveness and toxicity of nTRP were defined based on previous assessments, literature, and expert discussions. Our model will aid in identifying key risk factors contributing to increased risk of adverse health effects for a product in a qualitative manner. Additionally, it can gauge attractiveness for specific user groups, as a determinant for population prevalence of use. Our model can be used to identify aspects of nTRP that require attention for public information or product regulation. As an example, we applied this to JUUL, a popular e-cigarette in the US. Aspects of concern for JUUL are its attractive and discrete shape, user-friendly prefilled pods, flavors, high aerosol nicotine levels, and liquids containing nicotine salts instead of free-based nicotine. The addictiveness and especially attractiveness are sufficiently high to have a large potential impact on population health due to its contribution to use and hence exposure. Products and their use can change over time; therefore market research and monitoring are crucial.
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7
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Donny EC, White CM. A review of the evidence on cigarettes with reduced addictiveness potential. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103436. [PMID: 34535366 PMCID: PMC8785120 DOI: 10.1016/j.drugpo.2021.103436] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022]
Abstract
Background In May 2018, the Secretariat for the World Health Organization Framework Convention on Tobacco Control convened a meeting to discuss the potential for reducing the addictiveness of tobacco products. A central focus was to review research findings on the behavioral effects of reducing the addictiveness of cigarettes. Methods This manuscript reports the results of a review of the behavioral science literature, updated through April 2021, with special attention to both the potential benefits and unintended consequences of reducing nicotine in cigarettes. Results Available evidence suggests that reducing nicotine content in cigarettes to very low levels could benefit public health in three primary ways, by 1) decreasing uptake of regular smoking, 2) decreasing the amount people smoke, and 3) increasing the likelihood of smoking cessation. Current evidence also suggests that reducing nicotine in cigarettes may produce similar benefits across many important subpopulations of people who smoke, including those with psychiatric comorbidities, those who use other substances, those with low socioeconomic status, young people, people who smoke infrequently and people who prefer menthol cigarettes. Cigarette nicotine reduction could also lead to some undesirable outcomes, such as experiencing withdrawal, product manipulation, an illicit market, and harm misperceptions; strategies that may mitigate each are discussed. Conclusion Overall, behavioral research suggests product standards that limit the nicotine content of combusted tobacco products could render cigarettes and similar products less addictive. The availability of legal, non-combusted products that effectively substitute for cigarettes and the dissemination of public health campaigns that clarify misperceptions about the relationship between nicotine, tobacco and disease may facilitate the extent to which a nicotine reduction policy reduces smoking.
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Affiliation(s)
- Eric C Donny
- Wake Forest University School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, NC, USA.
| | - Cassidy M White
- Wake Forest University School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, NC, USA
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Krebs NM, Zhu J, Wasserman E, Kuprewicz R, Martinez DJ, Veldheer S, Livelsberger C, Modesto J, Reinhart L, Trushin N, Reilly SM, Liao J, Fazzi A, Bascom R, Richie JP, Foulds J, Horn K, Muscat JE. Switching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical Trial. Nicotine Tob Res 2021; 23:992-1001. [PMID: 33249498 PMCID: PMC8150128 DOI: 10.1093/ntr/ntaa247] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Food and Drug Administration issued an advanced notice of proposed rulemaking for setting a product standard for nicotine levels in cigarettes, with an emphasis on minimally or non-addicting very low nicotine content (VLNC). METHODS A 33 week, two-arm, double-blind randomized trial conducted in Hershey, Pennsylvania, USA and Washington, DC, USA included adult daily cigarette smokers (≥5 cigarettes per day) with less than a college degree, and who had no plans to quit within the next six months. Participants were randomized to either reduced nicotine content (RNC) study cigarettes tapered every three weeks to a final VLNC (0.2 mg/cigarette) for six weeks or to usual nicotine content (UNC) study cigarettes (11.6 mg/cigarette). Outcomes included acceptability of study cigarettes measured by attrition (primary outcome), compliance, reduction in cigarette dependence and tobacco biomarkers, and post-intervention cessation. RESULTS The RNC (n = 122) versus UNC (n = 123) group had higher attrition (adjusted Hazard Ratio 3.4; 95% confidence interval [CI] 1.99 to 5.81). At the end of the intervention, cotinine levels were 50% lower in the RNC group (mean group difference -137 ng/mL; 95% CI -172, -102). The RNC group smoked fewer CPD (-4.1; 95% CI -6.44, -1.75) and had lower carbon monoxide levels (-4.0 ppm; 95% CI -7.7, -0.4). Forty seven percent (29/62) of the RNC group were biochemically-confirmed compliant with smoking VLNC cigarettes (mean cotinine = 8.9 ng/ml). At three month follow-up, only compliant VLNC smokers quit with an assisted quit attempt (N = 6/22, 27%). CONCLUSIONS This study supports a VLNC standard in cigarettes. IMPLICATIONS Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.
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Affiliation(s)
- Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Robin Kuprewicz
- Department of Psychiatry, Georgetown University, Washington, DC
| | - Diane J Martinez
- Public Health Division, Arlington County Department of Human Services, Arlington, VA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
- Department of Family and Community Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jennifer Modesto
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Samantha M Reilly
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Alyse Fazzi
- Department of Pharmacy, Investigational Drug Service Pharmacy, Penn State Health, Hershey, PA
| | - Rebecca Bascom
- Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Roanoke, VA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
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Dermody SS, Tessier KM, Meier E, al'Absi M, Denlinger-Apte RL, Drobes DJ, Jensen J, Koopmeiners JS, Pacek LR, Tidey JW, Vandrey R, Donny E, Hatsukami D. An Evaluation of Potential Unintended Consequences of a Nicotine Product Standard: A Focus on Drinking History and Outcomes. Nicotine Tob Res 2020; 23:1168-1175. [PMID: 33220047 DOI: 10.1093/ntr/ntaa236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION A nicotine product standard reducing the nicotine content in cigarettes could improve public health by reducing smoking. This study evaluated the potential unintended consequences of a reduced nicotine product standard by examining its effects on (1) smoking behaviors based on drinking history; (2) drinking behavior; and (3) daily associations between smoking and drinking. METHODS Adults who smoke daily (n = 752) in the United States were randomly assigned to smoke very low nicotine content (VLNC) cigarettes versus normal nicotine content (NNC; control) cigarettes for 20 weeks. Linear mixed models determined if baseline drinking moderated the effects of VLNC versus NNC cigarettes on Week 20 smoking outcomes. Time-varying effect models estimated the daily association between smoking VLNC cigarettes and drinking outcomes. RESULTS Higher baseline alcohol use (vs no use or lower use) was associated with a smaller effect of VLNC on Week 20 urinary total nicotine equivalents (ps < .05). No additional moderation was supported (ps > .05). In the subsample who drank (n = 415), in the VLNC versus NNC condition, daily alcohol use was significantly reduced from Weeks 17 to 20 and odds of binge drinking were significantly reduced from Weeks 9 to 17. By Week 7, in the VLNC cigarette condition (n = 272), smoking no longer predicted alcohol use but remained associated with binge drinking. CONCLUSIONS We did not support negative unintended consequences of a nicotine product standard. Nicotine reduction in cigarettes generally affected smoking behavior for individuals who do not drink or drink light-to-moderate amounts in similar ways. Extended VLNC cigarette use may improve public health by reducing drinking behavior. IMPLICATIONS There was no evidence that a VLNC product standard would result in unintended consequences based on drinking history or when considering alcohol outcomes. Specifically, we found that a very low nicotine standard in cigarettes generally reduces smoking outcomes for those who do not drink and those who drink light-to-moderate amounts. Furthermore, an added public health benefit of a very low nicotine standard for cigarettes could be a reduction in alcohol use and binge drinking over time. Finally, smoking VLNC cigarettes may result in a decoupling of the daily associations between smoking and drinking.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Ellen Meier
- Department of Psychology, University of Wisconsin-Stevens Point, USA
| | - Mustafa al'Absi
- Masonic Cancer Center, University of Minnesota, Duluth, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David J Drobes
- Tobacco Research and Intervention Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, Duluth, MN, USA
| | | | - Lauren R Pacek
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Eric Donny
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Nicotine reduction does not alter essential value of nicotine or reduce cue-induced reinstatement of nicotine seeking. Drug Alcohol Depend 2020; 212:108020. [PMID: 32362438 PMCID: PMC7293915 DOI: 10.1016/j.drugalcdep.2020.108020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 01/10/2023]
Abstract
Reduction of nicotine content in tobacco products is a regulatory control strategy intended to decrease smoking dependence, and is hypothesized to produce gradual reductions of nicotine intake. Rats were initially trained to self-administer 0.06 mg/kg/infusion nicotine (Phase 1), which was followed by a threshold procedure to determine nicotine demand via a behavioral economics (BE) paradigm (Phase 2). Rats then either self-administered the training dose (high dose group), or were switched to a low dose of nicotine (0.001 mg/kg/infusion; low dose group) in Phase 3. Both groups then underwent a second threshold procedure and demand curves were re-determined (Phase 4). In Phase 5, responding for nicotine was extinguished over the course of 21 sessions. Cue-induced reinstatement was then evaluated (Phase 6). Rats in the low dose group maintained a steady amount of infusions, and thus, did not compensate for nicotine reduction. Rats in the low dose group also showed similar demand elasticity and nicotine seeking (Phase 6) compared to the high dose group, indicating that nicotine reduction did not decrease nicotine demand or seeking. Further, both groups displayed resistance to extinction, indicating that nicotine reduction did not facilitate extinction learning. These results suggest that although compensation of intake does not occur, decreasing the dose of nicotine does not alter nicotine reinforcement value or relapse vulnerability. Further, these results indicate persistence of nicotine-motivated behavior after self-administration of a low nicotine dose. Translationally, these results suggest that alternative strategies may be needed to achieve positive smoking cessation outcomes.
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Affiliation(s)
- Timothy B Baker
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), Madison
| | - Michael C Fiore
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), Madison
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Ribisl KM, Hatsukami DK, Huang J, Williams RS, Donny EC. Strategies to Reduce Illicit Trade of Regular Nicotine Tobacco Products After Introduction of a Low-Nicotine Tobacco Product Standard. Am J Public Health 2020; 109:1007-1014. [PMID: 31166743 DOI: 10.2105/ajph.2019.305067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The US Food and Drug Administration is considering mandating a substantial reduction in the nicotine level of cigarettes and possibly other combusted tobacco products to render them minimially addictive. This would likely result in several public health benefits, including increased cessation, decreased progression to dependence, and reduced consumption of combusted tobacco products. However, findings from clinical trials of reduced-nicotine cigarettes suggest that many smokers consuming low nicotine-content cigarettes sought out regular nicotine-content cigarettes, even when they were asked to only smoke free low-nicotine cigarettes. If this policy were implemented without ensuring that cessation treatments and appealing alternative products (e.g., e-cigarettes) were readily available, some consumers would be likely to seek banned regular nicotine-content combusted tobacco products from illicit sources: retail, online, and individuals. Left unchecked, this illicit market could undermine the public health benefits of the policy. We describe supply and demand factors in an illicit market. Informed by the literature on controlling Internet tobacco sales and reducing illicit trade in low-cost cigarettes when there are price differentials, we recommend tracking and tracing products and greater surveillance and enforcement efforts to minimize illicit trade in normal nicotine products under a low-nicotine tobacco product standard.
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Affiliation(s)
- Kurt M Ribisl
- Kurt M. Ribisl is with the Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Dorothy K. Hatsukami is with the Department of Psychiatry, University of Minnesota, Minneapolis. Jidong Huang is with the School of Public Health, Georgia State University, Atlanta. Rebecca S. Williams is with the Lineberger Comprehensive Cancer Center and the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill. Eric C. Donny is with Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dorothy K Hatsukami
- Kurt M. Ribisl is with the Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Dorothy K. Hatsukami is with the Department of Psychiatry, University of Minnesota, Minneapolis. Jidong Huang is with the School of Public Health, Georgia State University, Atlanta. Rebecca S. Williams is with the Lineberger Comprehensive Cancer Center and the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill. Eric C. Donny is with Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jidong Huang
- Kurt M. Ribisl is with the Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Dorothy K. Hatsukami is with the Department of Psychiatry, University of Minnesota, Minneapolis. Jidong Huang is with the School of Public Health, Georgia State University, Atlanta. Rebecca S. Williams is with the Lineberger Comprehensive Cancer Center and the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill. Eric C. Donny is with Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rebecca S Williams
- Kurt M. Ribisl is with the Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Dorothy K. Hatsukami is with the Department of Psychiatry, University of Minnesota, Minneapolis. Jidong Huang is with the School of Public Health, Georgia State University, Atlanta. Rebecca S. Williams is with the Lineberger Comprehensive Cancer Center and the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill. Eric C. Donny is with Wake Forest University School of Medicine, Winston-Salem, NC
| | - Eric C Donny
- Kurt M. Ribisl is with the Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Dorothy K. Hatsukami is with the Department of Psychiatry, University of Minnesota, Minneapolis. Jidong Huang is with the School of Public Health, Georgia State University, Atlanta. Rebecca S. Williams is with the Lineberger Comprehensive Cancer Center and the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill. Eric C. Donny is with Wake Forest University School of Medicine, Winston-Salem, NC
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Patel M, Cuccia AF, Czaplicki L, Donovan EM, Simard B, Pitzer L, Hair EC, Schillo BA, Vallone DM. Smokers' behavioral intentions in response to a low-nicotine cigarette policy. Drug Alcohol Depend 2019; 205:107645. [PMID: 31704376 DOI: 10.1016/j.drugalcdep.2019.107645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/28/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evidence suggests that reducing the nicotine concentration in cigarettes to sub-addictive levels would reduce use. Until a low-nicotine cigarette policy is enacted, population-level effects are unknown. This study examines the behavioral intentions of current U.S. cigarette smokers if a low-nicotine policy were implemented. METHODS Data were drawn from a nationally representative probability-based panel and opt-in panel. Weighted logistic regressions examined likelihood to (1) smoke lower nicotine cigarettes, (2) quit using tobacco, (3) use e-cigarettes, (4) illegally buy high-nicotine cigarettes, and (5) smoke cigars, cigarillos, or little cigars (CLCCs) among smokers, controlling for demographics, tobacco products used, dependence, and intentions to quit cigarettes. Latent class analyses (LCA) characterized patterns of behavioral intentions. RESULTS If a low-nicotine policy were implemented, most participants indicated a likelihood to smoke low-nicotine cigarettes (78.4%) or quit tobacco (61.9%), followed by use e-cigarettes (46.5%). Individuals with greater dependence had greater odds of intending to smoke low-nicotine cigarettes, use e-cigarettes, and illegally buy high-nicotine cigarettes. Current e-cigarette or CLCCs users had higher odds of intending to use these products. LCA revealed that individuals would 1) use low-nicotine cigarettes with low intentions to use other tobacco products or 2) use multiple tobacco products, including low-nicotine cigarettes. CONCLUSIONS A reduced nicotine standard for all combustible tobacco products is needed given that many tobacco users would likely intend to continue to use tobacco products. Differences in intentions by tobacco use and demographic characteristics indicate a need for additional cessation support and education around the harms of continued use of combustible tobacco.
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Affiliation(s)
- Minal Patel
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Alison F Cuccia
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Lauren Czaplicki
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Emily M Donovan
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Bethany Simard
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Lindsay Pitzer
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Elizabeth C Hair
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Barbara A Schillo
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Donna M Vallone
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Global Institute of Public Health, New York University, New York, NY 10012, USA.
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14
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Berman ML, Bickel WK, Harris AC, LeSage MG, O'Connor RJ, Stepanov I, Shields PG, Hatsukami DK. Consortium on Methods Evaluating Tobacco: Research Tools to Inform US Food and Drug Administration Regulation of Snus. Nicotine Tob Res 2019; 20:1292-1300. [PMID: 29059363 DOI: 10.1093/ntr/ntx228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/28/2017] [Indexed: 11/13/2022]
Abstract
Introduction The US Food and Drug Administration (FDA) has purview over tobacco products. To set policy, the FDA must rely on sound science, yet most existing tobacco research methods have not been designed to specifically inform regulation. The NCI and FDA-funded Consortium on Methods Evaluating Tobacco (COMET) was established to develop and assess valid and reliable methods for tobacco product evaluation. The goal of this article is to describe these assessment methods using a US manufactured "snus" as the test product. Methods In designing studies that could inform FDA regulation, COMET has taken a multidisciplinary approach that includes experimental animal models and a range of human studies that examine tobacco product appeal, addictiveness, and toxicity. This article integrates COMET's findings over the last 4 years. Results Consistency in results was observed across the various studies, lending validity to our methods. Studies showed low abuse liability for snus and low levels of consumer demand. Toxicity was less than cigarettes on some biomarkers but higher than medicinal nicotine. Conclusions Using our study methods and the convergence of results, the snus that we tested as a potential modified risk tobacco product is likely to neither result in substantial public health harm nor benefit. Implications This review describes methods that were used to assess the appeal, abuse liability, and toxicity of snus. These methods included animal, behavioral economics, consumer perception studies, and clinical trials. Across these varied methods, study results showed low abuse-liability and appeal of the snus product we tested. In several studies, demand for snus was lower than for less toxic nicotine gum. The consistency and convergence of results across a range of multi-disciplinary studies lends validity to our methods and suggests that promotion of snus as a modified risk tobacco products is unlikely to produce substantial public health benefit or harm.
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Affiliation(s)
- Micah L Berman
- College of Public Health, Ohio State University, Columbus, OH.,Moritz College of Law, Ohio State University, Columbus, OH
| | | | - Andrew C Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN.,Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Mark G LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN.,Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Peter G Shields
- Comprehensive Cancer Center, Ohio State University, Columbus, OH
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15
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Branstetter SA, Nye R, Sipko JJ, Muscat JE. The Effect of Price on the Consumption of Reduced Nicotine Cigarettes. Nicotine Tob Res 2019; 21:955-961. [PMID: 30137465 PMCID: PMC6588386 DOI: 10.1093/ntr/nty169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/17/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Price affects the demand for cigarettes, indicating that smokers, perhaps especially lower income smokers, may choose low nicotine cigarettes (LNC) if they were commercially available and cost less than fully nicotinized conventional cigarettes. The present study tests the hypothesis that smokers will prefer purchasing LNCs at a lower price point than conventional cigarettes given a fixed budget. METHOD A laboratory-based, within-subject, 3 (nicotine level) × 3 (price) factorial design provided smokers opportunities to purchase standard (0.7 per mg tobacco), moderately reduced (0.3 mg), and very low-nicotine (0.03 mg). Spectrum research cigarettes according to an escalating price structure (low-nicotine costing the least, high-nicotine costing the most) given a fixed, laboratory-provided "income." Participants were 20 overnight-abstinent smokers who previously smoked and rated each of the three cigarettes. RESULTS Overall, smokers rated LNCs as less satisfying compared with standard nicotine cigarettes (SNC), t(18) = -5.40, p < .001. In the free-choice session, subjects were more likely to choose LNC that cost less compared with SNC that cost more, even after an 8-hour abstinence period, F(2, 19) = 4.32, p = .03. Those selecting LNC or moderate nicotine cigarettes after abstinence smoked more cigarettes per day, t(17) = 2.40, p = .03 and had higher dependence scores on the HONC, t(18) = 2.21, p = .04 that those selecting SNC. CONCLUSION The results indicate that smokers' response to price points when purchasing cigarettes may extend to LNC if these were commercially available. Differential cigarette prices based on nicotine content may result in voluntary selection of less addicting products. IMPLICATIONS The Food and Drug Administration has proposed a rule that would reduce nicotine content in commercially available cigarettes. However, it is not known how smokers may respond in an environment where products of differing nicotine content and of differing prices are available. This study demonstrates that price may be an important factor that could lead smokers to select reduced nicotine products voluntarily, even if those products are rated as inferior or less satisfying.
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Affiliation(s)
- Steven A Branstetter
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Russell Nye
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Joseph J Sipko
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Joshua E Muscat
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA
- Public Health Science, Milton S. Hershey Medical School, Pennsylvania State University, Hershey, PA
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16
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Benowitz NL, Henningfield JE. Nicotine Reduction Strategy: State of the science and challenges to tobacco control policy and FDA tobacco product regulation. Prev Med 2018; 117:5-7. [PMID: 29944901 DOI: 10.1016/j.ypmed.2018.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
Nicotine addiction is the proximate cause of disease and death from cigarette smoking. In 1994, we proposed reducing the nicotine content of cigarettes to non-addicting levels to reduce the risk of youth becoming addicted smokers and promoting quitting in established smokers. In 2009, the Family Smoking Prevention and Tobacco Control Act provided the authority to FDA to reduce nicotine levels as appropriate to benefit public health. Over the past 15 years, considerable research has determined that nicotine reduction is feasible and safe, resulting in reduced nicotine dependence with little evidence of compensatory over-smoking. The availability of acceptable non-combusted form of nicotine would provide support and enhance acceptability of nicotine reduction in tobacco. Most recently, the FDA promulgated a nicotine-based regulatory framework, which includes nicotine reduction combined with ready availability of noncombustible nicotine products. Nicotine reduction could contribute to a virtual end to the use of cigarette smoking, with enormous benefits to public health.
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Affiliation(s)
- Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, Departments of Medicine, and Biopharmaceutical Sciences, Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA.
| | - Jack E Henningfield
- Pinney Associates Inc., Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, USA
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17
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Braverman-Bronstein A, Thrasher JF, Reynales-Shigematsu LM, Hernández-Ávila M, Barrientos-Gutierrez T. Concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes in Mexico. Harm Reduct J 2018; 15:50. [PMID: 30285882 PMCID: PMC6171311 DOI: 10.1186/s12954-018-0257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/24/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers. METHODS Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests. RESULTS Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p < 0001), glycerol (12.98 ± 8.03 vs 2.93 ± 1.96 mg/g; p < 0.001), and N-nitrosanatabine (NAT) (1087.5 ± 127.0 vs 738.5 ± 338 ng/g; p = 0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations. CONCLUSION Compared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policy-makers; and to limit cigarette engineering from the tobacco industry.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
| | - Luz Myriam Reynales-Shigematsu
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Mauricio Hernández-Ávila
- National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Tonatiuh Barrientos-Gutierrez
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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18
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LeSage MG, Smethells JR, Harris AC. Status and Future Directions of Preclinical Behavioral Pharmacology in Tobacco Regulatory Science. ACTA ACUST UNITED AC 2018; 18:252-274. [PMID: 30214916 DOI: 10.1037/bar0000113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral pharmacology is a branch of the experimental analysis of behavior that has had great influence in drug addiction research and policy. This paper provides an overview of recent behavioral pharmacology research in the field of tobacco regulatory science, which provides the scientific foundation for the Food and Drug Administration Center for Tobacco Products (FDA CTP) to set tobacco control policies. The rationale and aims of tobacco regulatory science are provided, including the types of preclinical operant behavioral models it deems important for assessing the abuse liability of tobacco products and their constituents. We then review literature relevant to key regulatory actions being considered by the FDA CTP, including regulations over nicotine and menthol content of cigarettes, and conclude with suggesting some directions for future research. The current era of tobacco regulatory science provides great opportunities for behavioral pharmacologists to address the leading cause of preventable death and disease worldwide.
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Affiliation(s)
- Mark G LeSage
- Department of Medicine, Minneapolis Medical Research Foundation
- Departments of Medicine, University of Minnesota
- Department of Psychology, University of Minnesota
| | - John R Smethells
- Department of Medicine, Minneapolis Medical Research Foundation
- Departments of Medicine, University of Minnesota
| | - Andrew C Harris
- Department of Medicine, Minneapolis Medical Research Foundation
- Departments of Medicine, University of Minnesota
- Department of Psychology, University of Minnesota
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Apelberg BJ, Feirman SP, Salazar E, Corey CG, Ambrose BK, Paredes A, Richman E, Verzi SJ, Vugrin ED, Brodsky NS, Rostron BL. Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States. N Engl J Med 2018. [PMID: 29543114 DOI: 10.1056/nejmsr1714617] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Benjamin J Apelberg
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Shari P Feirman
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Esther Salazar
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Catherine G Corey
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Bridget K Ambrose
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Antonio Paredes
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Elise Richman
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Stephen J Verzi
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Eric D Vugrin
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Nancy S Brodsky
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Brian L Rostron
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
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20
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Smith TT, Rupprecht LE, Denlinger-Apte RL, Weeks JJ, Panas RS, Donny EC, Sved AF. Animal Research on Nicotine Reduction: Current Evidence and Research Gaps. Nicotine Tob Res 2018; 19:1005-1015. [PMID: 28379511 DOI: 10.1093/ntr/ntx077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/31/2017] [Indexed: 01/21/2023]
Abstract
A mandated reduction in the nicotine content of cigarettes may improve public health by reducing the prevalence of smoking. Animal self-administration research is an important complement to clinical research on nicotine reduction. It can fill research gaps that may be difficult to address with clinical research, guide clinical researchers about variables that are likely to be important in their own research, and provide policy makers with converging evidence between clinical and preclinical studies about the potential impact of a nicotine reduction policy. Convergence between clinical and preclinical research is important, given the ease with which clinical trial participants can access nonstudy tobacco products in the current marketplace. Herein, we review contributions of preclinical animal research, with a focus on rodent self-administration, to the science of nicotine reduction. Throughout this review, we highlight areas where clinical and preclinical research converge and areas where the two differ. Preclinical research has provided data on many important topics such as the threshold for nicotine reinforcement, the likelihood of compensation, moderators of the impact of nicotine reduction, the impact of environmental stimuli on nicotine reduction, the impact of nonnicotine cigarette smoke constituents on nicotine reduction, and the impact of nicotine reduction on vulnerable populations. Special attention is paid to current research gaps including the dramatic rise in alternative tobacco products, including electronic nicotine delivery systems (ie, e-cigarettes). The evidence reviewed here will be critical for policy makers as well as clinical researchers interested in nicotine reduction. IMPLICATIONS This review will provide policy makers and clinical researchers interested in nicotine reduction with an overview of the preclinical animal research conducted on nicotine reduction and the regulatory implications of that research. The review also highlights the utility of preclinical research for research questions related to nicotine reduction.
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Affiliation(s)
- Tracy T Smith
- University of Pittsburgh Cancer Institute, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Laura E Rupprecht
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA
| | - Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Jillian J Weeks
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA
| | - Rachel S Panas
- Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Alan F Sved
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA.,Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA
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21
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Denlinger-Apte RL, Joel DL, Strasser AA, Donny EC. Low Nicotine Content Descriptors Reduce Perceived Health Risks and Positive Cigarette Ratings in Participants Using Very Low Nicotine Content Cigarettes. Nicotine Tob Res 2017; 19:1149-1154. [PMID: 28003507 PMCID: PMC5896530 DOI: 10.1093/ntr/ntw320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/30/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Understanding how smokers perceive reduced nicotine content cigarettes will be important if the FDA and global regulatory agencies implement reduced nicotine product standards for cigarettes. Prior research has shown that some smokers incorrectly believe "light" cigarettes are less harmful than regular cigarettes. Similar misunderstandings of health risk could also apply to reduced nicotine cigarettes. To date, most studies of reduced nicotine cigarettes have blinded subjects to the nicotine content. Therefore, little is known about how smokers experience reduced nicotine content cigarettes when they are aware of the reduced content, and how use may be impacted. METHODS The present study was a within-subjects experiment with 68 adult daily smokers who smoked two identical very low nicotine content Quest 3 (0.05 mg nicotine yield) cigarettes. Subjects were told that one cigarette contained "average" nicotine content, and the other contained "very low" nicotine content. After smoking each cigarette, subjects completed subjective measures about their smoking experience. RESULTS Subjects rated the "very low" nicotine cigarette as less harmful to their health overall compared to the "average" nicotine cigarette; this effect held true for specific smoking-related diseases. Additionally, they rated the "very low" nicotine cigarette as having less desirable subjective effects than the "average" nicotine cigarette and predicted having greater interest in quitting smoking in the future if only the "very low" nicotine cigarette was available. CONCLUSIONS Explicit knowledge of very low nicotine content changes smokers' perceptions of very low nicotine content cigarettes, resulting in reduced predicted harm, subjective ratings and predicted future use. IMPLICATIONS Before a reduced nicotine product standard for cigarettes can be implemented, it is important to understand how product information impacts how smokers think about and experience very low nicotine content cigarettes. Prior research has shown that smokers incorrectly believed light cigarettes were less harmful products. As such, smokers may also misunderstand the health risks associated with smoking very low nicotine content cigarettes. This study highlights the importance of smokers' perceptions of nicotine content in cigarettes on the perceived health risks and the subjective effects of smoking very low nicotine content cigarettes.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI
| | - Danielle L Joel
- Department of Psychology, School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Andrew A Strasser
- Department of Psychiatry, Perelmen School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric C Donny
- Department of Psychology, School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA
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Perkins KA, Kunkle N, Karelitz JL, Perkins KA, Kunkle N, Karelitz JL. Preliminary test of cigarette nicotine discrimination threshold in non-dependent versus dependent smokers. Drug Alcohol Depend 2017; 175:36-41. [PMID: 28380366 PMCID: PMC5480896 DOI: 10.1016/j.drugalcdep.2017.01.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite its potential for understanding tobacco dependence, behavioral discrimination of nicotine via smoking has not been formally examined as a function of nicotine dependence level. METHODS Spectrum research cigarettes were used to compare non-dependent with dependent smokers on the lowest content of nicotine they could discriminate (i.e., "threshold"). Dependent (n=21; 16M, 5F) or non-dependent (n=7; 4M, 3F) smokers were tested on ability to discriminate between cigarettes with nicotine contents of 17, 11, 5, 2, and 1mg/g, one per session, from an "ultra-low" cigarette with 0.4mg/g (all had 9-10mg "tar"). All abstained from smoking overnight prior to sessions, and number of sessions was determined by the lowest nicotine content they could reliably discriminate from the ultra-low on >80% of trials (i.e., ≥5 of 6). Subjective perceptions and cigarette choice behavior were also assessed and related to discrimination behavior. RESULTS Discrimination thresholds (and most perceptions) did not differ between dependent and non-dependent smokers, with median thresholds of 11mg/g for both subgroups. Yet, "liking" and puff choice for threshold cigarettes were greater in dependent but not non-dependent smokers, while cigarettes with nicotine contents below threshold did not support "liking" or choice in both groups. CONCLUSIONS In sum, this preliminary study suggests threshold for discriminating nicotine via smoking may not vary by dependence level, and further study is needed to confirm that cigarettes unable to be discriminated are also not reinforcing.
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Affiliation(s)
- Kenneth A Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Nicole Kunkle
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Joshua L Karelitz
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - K A Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - N Kunkle
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - J L Karelitz
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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23
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Perkins KA, Kunkle N, Karelitz JL. Threshold dose for behavioral discrimination of cigarette nicotine content in menthol vs. non-menthol smokers. Psychopharmacology (Berl) 2017; 234:1255-1265. [PMID: 28210778 DOI: 10.1007/s00213-017-4563-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/03/2017] [Indexed: 01/01/2023]
Abstract
RATIONALE The lowest threshold content (or "dose") of nicotine discriminated in cigarettes may differ due to menthol preference. OBJECTIVES Menthol and non-menthol Spectrum research cigarettes differing in nicotine content were used to determine discrimination thresholds. METHODS Dependent smokers preferring menthol (n = 40) or non-menthol (n = 21) brands were tested on ability to discriminate cigarettes (matched for their menthol preference) with nicotine contents of 16-17, 11-12, 5, 2, and 1 mg/g, one per session, from an "ultra-low" cigarette with 0.4 mg/g. Controlled exposure to each cigarette was four puffs/trial, and the number of sessions was determined by the lowest nicotine content they could discriminate on >80% of trials (i.e., ≥5 of 6). We also assessed subjective perceptions and behavioral choice between cigarettes to relate them to discrimination responses. RESULTS Controlling for Fagerstrom Test of Nicotine Dependence score, discrimination thresholds were more likely to be at higher nicotine content cigarettes for menthol vs. non-menthol smokers (p < .005), with medians of 16 vs. 11 mg/g, respectively. Compared to the ultra-low, threshold and subthreshold (next lowest) cigarettes differed on most perceptions and puff choice, but menthol preference did not alter these associations. Notably, threshold cigarettes did, but subthreshold did not, increase choice over the ultra-low. CONCLUSIONS Threshold for discriminating nicotine via smoking may be generally higher for menthol vs. non-menthol smokers. More research is needed to identify why menthol smoking is related to higher nicotine thresholds and to verify that cigarettes unable to be discriminated do not support reinforcement.
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Affiliation(s)
- Kenneth A Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Nicole Kunkle
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Joshua L Karelitz
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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24
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Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior. Drug Alcohol Depend 2017; 173:99-106. [PMID: 28214392 PMCID: PMC5366263 DOI: 10.1016/j.drugalcdep.2016.12.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/06/2016] [Accepted: 12/21/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Tobacco advertising can create false beliefs about health harms that are reinforced by product design features. Reduced nicotine content (RNC) cigarettes may reduce harm, but research has not addressed advertising influences. This study examined RNC cigarette advertising effects on false harm beliefs, and how these beliefs - along with initial subjective ratings of RNC cigarettes - affect subsequent smoking behaviors. We further explored whether subjective ratings moderate associations between false beliefs and behavior. METHODS Seventy-seven daily, non-treatment-seeking smokers (66.2% male) participated in the first 15days of a randomized, controlled, open-label RNC cigarette trial. Participants viewed an RNC cigarette advertisement at baseline before completing a 5-day period of preferred brand cigarette use, followed by a 10-day period of RNC cigarette use (0.6mg nicotine yield). Participants provided pre- and post-advertisement beliefs, and subjective ratings and smoking behaviors for cigarettes smoked during laboratory visits. RESULTS Viewing the advertisement increased beliefs that RNC cigarettes contain less nicotine and are healthier than regular cigarettes (p's<0.001 and 0.011), and decreased the belief that they are less likely to cause cancer (p=0.046). Neither false beliefs nor subjective ratings directly affected smoking behaviors. Significant interactions of strength and taste ratings with beliefs (p's<0.001), however, indicated that among smokers with less negative initial subjective ratings, greater false beliefs were associated with greater RNC cigarette consumption. CONCLUSIONS Smokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.
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25
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Hatsukami DK, Luo X, Dick L, Kangkum M, Allen SS, Murphy SE, Hecht SS, Shields P, al’Absi M. Reduced nicotine content cigarettes and use of alternative nicotine products: exploratory trial. Addiction 2017; 112:156-167. [PMID: 27614097 PMCID: PMC5249662 DOI: 10.1111/add.13603] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/19/2016] [Accepted: 08/30/2016] [Indexed: 01/25/2023]
Abstract
AIMS To compare the use of alternative nicotine products, smoking behavior and tobacco biomarker exposure in smokers unwilling to quit who were assigned randomly to normal nicotine content (NNC) cigarettes or very low nicotine content (VLNC) cigarettes. DESIGN Randomized, parallel-arm 8-week study with assignment to VLNC (VLNC 1, n = 53) or NNC (NNC, n = 27) with access to non-cigarette combusted and non-combusted tobacco/nicotine products or to VLNC with access to only non-combusted products (VLNC2, n = 56). SETTING Clinics in Minnesota, USA. PARTICIPANTS Smokers uninterested in quitting smoking with a mean [± standard deviation (SD)] age of 44 (± 14) years and smoking 16 (± seven) cigarettes/day; 51% female, 72% white. MEASUREMENTS During the experimental period, the measures taken included: rate of alternative products used, amount of and abstinence from combusted tobacco used and tobacco exposure biomarkers. FINDINGS There were higher rates of non-combusted alternative tobacco/nicotine product use in both VLNC conditions versus the NNC condition [rate ratio (RR) = 2.18, 95% confidence interval (CI) = 1.94, 2.46 and RR = 1.64, 95% CI = 1.46, 1.85, respectively] and in VLNC1 versus VLNC2 condition (RR = 1.33, 95% CI = 1.23, 1.44), accompanied by reduced biomarkers of exposure primarily in VLNC2 condition compared to NNC condition (Ps < 0.05). Fewer combusted products were smoked at almost all visits (Ps ≤ 0.02) and there were higher rates of abstinence for both VLNC conditions compared with the NNC condition (VLNC1 versus NNC: RR = 9.96, 95% CI = 5.01, 19.81; VLNC2 versus NNC: RR = 11.23, 95% CI = 5.74, 21.97). CONCLUSION The offer of, and instructions to use, reduced nicotine content cigarettes during an 8-week period led to greater use of alternative tobacco/nicotine products compared with continued use of normal nicotine cigarettes and also reductions in smoking rates.
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Affiliation(s)
- Dorothy K. Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura Dick
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Margarita Kangkum
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Sharon S. Allen
- Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sharon E. Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Peter Shields
- James Cancer Center, Ohio State University, Columbus, OH, USA
| | - Mustafa al’Absi
- Duluth Medical Research Institute, University of Minnesota, Duluth, MN, USA
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Nardone N, Donny EC, Hatsukami DK, Koopmeiners JS, Murphy SE, Strasser AA, Tidey JW, Vandrey R, Benowitz NL. Estimations and predictors of non-compliance in switchers to reduced nicotine content cigarettes. Addiction 2016; 111:2208-2216. [PMID: 27367436 PMCID: PMC5203964 DOI: 10.1111/add.13519] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/15/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Clinical trials on the impact and safety of reduced nicotine content cigarettes (RNCs) are ongoing, and an important methodological concern is participant compliance with smoking only RNCs. Our aims were to measure non-compliance biochemically with urine cotinine (COT) and total nicotine equivalents (TNEs), compare with self-reported non-compliance and identify associated covariates. DESIGN Secondary analysis of a double-blind, parallel, randomized clinical trial. SETTING Research centers from the United States, enrolling participants from June 2013 to July 2014. PARTICIPANTS Volunteer sample of 242 participants (55% Caucasian), average age of 41.2 years, smoking at least five cigarettes per day (CPD). INTERVENTION Smoking very low nicotine cigarettes (VLNCs; 0.4 mg nicotine/g tobacco) for 6 weeks. MEASUREMENTS The primary outcome was biochemically verified non-compliance, measured as thresholds of COT/CPD and TNE/CPD ratios, considering changes in nicotine content from conventional levels to VLNCs, and as an absolute threshold of week 6 TNEs. Self-reported non-compliance was measured via daily phone calls. Key predictors included age, sex, race, menthol preference, nicotine metabolite ratio, time to first cigarette, dependence, CPD, TNEs, tar level and cigarette evaluation. FINDINGS Estimates of non-compliance with smoking the VLNCs exclusively include: the biochemical ratios (both 78%), the week 6 TNE threshold (76%) and self-report (39%). Of the key covariates, age, dependence and cigarette evaluations of satisfaction were significant; for age, younger participants more likely to be non-compliant [P = 0.01; odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.96-0.99]. Dependence was associated significantly with self-reported non-compliance (P = 0.01; OR = 1.28, 95% CI = 1.06-1.55). Cigarette evaluations of satisfaction were associated significantly with non-compliance (P = 0.001; OR = 0.71, 95% CI = 0.61-0.82). CONCLUSIONS Among smokers volunteering to smoke only very low nicotine cigarettes for 6 weeks, non-compliance was common and biochemical assessments detected more cases of non-compliance than self-report. Despite high levels of non-compliance, smokers reduced their intake of nicotine by an average of 60%.
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Affiliation(s)
- Natalie Nardone
- University of California, San Francisco, Department of Medicine, 3130 20th Street, Suite 308, San Francisco, CA 94110
| | - Eric C. Donny
- University of Pittsburgh, Department of Psychology, 210 S. Bouquet St, Pittsburgh, PA 15260
| | - Dorothy K. Hatsukami
- University of Minnesota, Department of Psychiatry, 717 Delaware St SE, Minneapolis, MN 55414
| | - Joseph S. Koopmeiners
- University of Minnesota, School of Public Health, 420 Delaware St. SE, Minneapolis, MN 55455
| | - Sharon E. Murphy
- University of Minnesota, Department of Biochemistry, Molecular Biology, & Biophysics, 2231 6th St SE, Minneapolis, MN 55455
| | - Andrew A. Strasser
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA 19104
| | - Jennifer W. Tidey
- Brown University, Department of Psychiatry & Human Behavior, Box G-S121-5, 121 South Main Street, Providence, RI 02903
| | - Ryan Vandrey
- Johns Hopkins University, Department of Psychiatry & Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - Neal L. Benowitz
- University of California, San Francisco, Department of Medicine and Bioengineering & Therapeutic Sciences, Box 1220, San Francisco, CA 94143-1220
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Baumung C, Rehm J, Franke H, Lachenmeier DW. Comparative risk assessment of tobacco smoke constituents using the margin of exposure approach: the neglected contribution of nicotine. Sci Rep 2016; 6:35577. [PMID: 27759090 PMCID: PMC5069659 DOI: 10.1038/srep35577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/16/2016] [Indexed: 12/11/2022] Open
Abstract
Nicotine was not included in previous efforts to identify the most important toxicants of tobacco smoke. A health risk assessment of nicotine for smokers of cigarettes was conducted using the margin of exposure (MOE) approach and results were compared to literature MOEs of various other tobacco toxicants. The MOE is defined as ratio between toxicological threshold (benchmark dose) and estimated human intake. Dose-response modelling of human and animal data was used to derive the benchmark dose. The MOE was calculated using probabilistic Monte Carlo simulations for daily cigarette smokers. Benchmark dose values ranged from 0.004 mg/kg bodyweight for symptoms of intoxication in children to 3 mg/kg bodyweight for mortality in animals; MOEs ranged from below 1 up to 7.6 indicating a considerable consumer risk. The dimension of the MOEs is similar to those of other tobacco toxicants with high concerns relating to adverse health effects such as acrolein or formaldehyde. Owing to the lack of toxicological data in particular relating to cancer, long term animal testing studies for nicotine are urgently necessary. There is immediate need of action concerning the risk of nicotine also with regard to electronic cigarettes and smokeless tobacco.
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Affiliation(s)
- Claudia Baumung
- Postgraduate Study for “Toxicology and Environmental Protection”, Institute for Legal Medicine, University of Leipzig, Leipzig, Germany
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany
| | - Jürgen Rehm
- Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie and Psychotherapie, Dresden, Germany
- Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Sciences, University of Toronto (UofT), Toronto, Canada
- Dalla Lana School of Public Health, UofT, Toronto, Canada
- Dept. of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada
- PAHO/WHO Collaborating Centre for Mental Health and Addiction, Toronto, Canada
| | - Heike Franke
- Postgraduate Study for “Toxicology and Environmental Protection”, Institute for Legal Medicine, University of Leipzig, Leipzig, Germany
- Rudolf Boehm Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Universität Leipzig, Leipzig, Germany
| | - Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany
- Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie and Psychotherapie, Dresden, Germany
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28
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Abstract
OBJECTIVES We sought to determine if negative responses to reduced nicotine content (RNC) cigarettes during open-label trials result from smokers' (negative) expectancies. We examined the effects of nicotine content description - independent of actual nicotine content - on subjective responses (craving reduction, withdrawal suppression, mood changes, and sensory ratings) and smoking behaviors (topography measures and carbon monoxide [CO] boost). METHODS Thirty-six 12-hour-abstinent daily smokers completed a 3-session crossover trial. During each session, participants smoked their preferred brand cigarette - blinded and described as containing "usual," "low," and "very low" nicotine content - through a topography device and completed CO and subjective response assessments. RESULTS Although nicotine content was identical, compared to the "usual" content cigarette, participants experienced less craving reduction after smoking the "very low" nicotine cigarette, and rated its smoke as weaker (p < .05). Participants took shallower puffs of the "low" nicotine cigarette (p < .05), and rated the "low" and "very low" nicotine cigarettes as weaker and too mild (p < .01). CONCLUSIONS Negative responses to RNC cigarettes may be due, in part, to negative expectancies about using cigarettes containing less nicotine. In this context, RNC cigarette marketing and labeling are likely important considerations if a federal nicotine reduction policy is initiated.
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29
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Tidey JW, Pacek LR, Koopmeiners JS, Vandrey R, Nardone N, Drobes DJ, Benowitz NL, Dermody SS, Lemieux A, Denlinger RL, Cassidy R, al'Absi M, Hatsukami DK, Donny EC. Effects of 6-Week Use of Reduced-Nicotine Content Cigarettes in Smokers With and Without Elevated Depressive Symptoms. Nicotine Tob Res 2016; 19:59-67. [PMID: 27613885 DOI: 10.1093/ntr/ntw199] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The FDA recently acquired regulatory authority over tobacco products, leading to renewed interest in whether reducing the nicotine content of cigarettes would reduce tobacco dependence in the United States. Given the association between depressive symptoms and cigarette smoking, it is important to consider whether smokers with elevated depressive symptoms experience unique benefits or negative consequences of nicotine reduction. METHODS In this secondary analysis of a randomized clinical trial that examined the effects of cigarettes varying in nicotine content over a 6-week period in non-treatment-seeking smokers, we used linear regression to examine whether baseline depressive symptom severity (scores on the Center for Epidemiologic Studies Depression Scale [CES-D]) moderated the effects of reduced-nicotine content (RNC) cigarettes, relative to normal-nicotine content (NNC) cigarettes, on smoking rates, depressive symptom severity, and related subjective and physiological measures. RESULTS Of the 717 participants included in this analysis, 109 (15.2%) had CES-D scores ≥ 16, indicative of possible clinical depression. Relative to NNC cigarettes, RNC cigarettes reduced smoking rates, nicotine dependence, and cigarette craving, and these effects were not significantly moderated by baseline CES-D score. A significant interaction between baseline CES-D score and cigarette condition on week 6 CES-D score was observed (p < .05); among those with CES-D scores ≥ 16 at baseline, those assigned to RNC cigarettes had lower week 6 CES-D scores than those assigned to NNC cigarettes. Among those in the lowest nicotine content conditions, biochemically confirmed compliance with the RNC cigarettes was associated with an increase in CES-D score for those with baseline CES-D scores < 16 and no change in CES-D score for those with baseline CES-D scores ≥ 16. CONCLUSIONS These findings provide initial evidence that a reduced-nicotine standard for cigarettes may reduce smoking, without worsening depressive symptoms, among smokers with elevated depressive symptoms. IMPLICATIONS This secondary analysis of a recent clinical trial examined whether depressive symptom severity moderated the effects of reduced-nicotine cigarettes on smoking and depressive symptoms. Results indicate that, regardless of baseline depressive symptoms, participants randomized to reduced-nicotine cigarettes had lower smoking rates, nicotine intake, nicotine dependence, and craving at week 6 post-randomization than those assigned to normal-nicotine cigarettes. In participants with higher baseline depressive symptoms, those assigned to reduced-nicotine cigarettes had lower week 6 depressive symptoms than those assigned to normal-nicotine cigarettes. These results suggest that a nicotine reduction policy could have beneficial effects for smokers, regardless of depressive symptom severity.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI;
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Joseph S Koopmeiners
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Natalie Nardone
- Department of Medicine, University of California-San Francisco, San Francisco, CA
| | - David J Drobes
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Neal L Benowitz
- Department of Medicine, University of California-San Francisco, San Francisco, CA
| | - Sarah S Dermody
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrine Lemieux
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN
| | | | - Rachel Cassidy
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI
| | - Mustafa al'Absi
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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30
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Smith TT, Rupprecht LE, Cwalina SN, Onimus MJ, Murphy SE, Donny EC, Sved AF. Effects of Monoamine Oxidase Inhibition on the Reinforcing Properties of Low-Dose Nicotine. Neuropsychopharmacology 2016; 41:2335-43. [PMID: 26955970 PMCID: PMC4946064 DOI: 10.1038/npp.2016.36] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/15/2016] [Accepted: 02/29/2016] [Indexed: 12/29/2022]
Abstract
The Food and Drug Administration (FDA) has the authority to regulate cigarette smoke constituents, and a reduction in nicotine content might benefit public health by reducing the prevalence of smoking. Research suggests that cigarette smoke constituents that inhibit monoamine oxidase (MAO) may increase the reinforcing value of low doses of nicotine. The aim of the present experiments was to further characterize the impact of MAO inhibition on the primary reinforcing and reinforcement enhancing effects of nicotine in rats. In a series of experiments, rats responded for intravenous nicotine infusions or a moderately-reinforcing visual stimulus in daily 1-h sessions. Rats received pre-session injections of known MAO inhibitors. The results show that (1) tranylcypromine (TCP), a known MAO inhibitor, increases sensitivity to the primary reinforcing effects of nicotine, shifting the dose-response curve for nicotine to the left, (2) inhibition of MAO-A, but not MAO-B, increases low-dose nicotine self-administration, (3) partial MAO-A inhibition, to the degree observed in chronic cigarette smokers, also increases low-dose nicotine self-administration, and (4) TCP decreases the threshold nicotine dose required for reinforcement enhancement. The results of the present experiments suggest cigarette smoke constituents that inhibit MAO-A, in the range seen in chronic smokers, are likely to increase the primary reinforcing and reinforcement enhancing effects of low doses of nicotine. If the FDA reduces the nicotine content of cigarettes, then variability in constituents that inhibit MAO-A could impact smoking.
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Affiliation(s)
- Tracy T Smith
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychology, University of Pittsburgh, 4120 Sennott Square, 210 S. Bouquet Street, Pittsburgh, PA 15260, USA, Tel: +1 412 624 8525, Fax: +1 412 624 4428, E-mail:
| | - Laura E Rupprecht
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Matthew J Onimus
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sharon E Murphy
- Department of Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alan F Sved
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
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31
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McClernon FJ, Froeliger B, Rose JE, Kozink RV, Addicott MA, Sweitzer MM, Westman EC, Van Wert DM. The effects of nicotine and non-nicotine smoking factors on working memory and associated brain function. Addict Biol 2016; 21:954-61. [PMID: 25904425 DOI: 10.1111/adb.12253] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Smoking abstinence impairs executive function, which may promote continued smoking behavior and relapse. The differential influence of nicotine and non-nicotine (i.e. sensory, motor) smoking factors and related neural substrates is not known. In a fully factorial, within-subjects design, 33 smokers underwent fMRI scanning following 24 hours of wearing a nicotine or placebo patch while smoking very low nicotine content cigarettes or remaining abstinent from smoking. During scanning, blood oxygenation level-dependent (BOLD) signal was acquired while participants performed a verbal N-back task. Following 24-hour placebo (versus nicotine) administration, accuracy on the N-back task was significantly worse and task-related BOLD signal lower in dorsomedial frontal cortex. These effects were observed irrespective of smoking. Our data provide novel evidence that abstinence-induced deficits in working memory and changes in underlying brain function are due in large part to abstinence from nicotine compared with non-nicotine factors. This work has implications both for designing interventions that target abstinence-induced cognitive deficits and for nicotine-reduction policy.
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Affiliation(s)
- Francis Joseph McClernon
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
- Duke-UNC Brain Imaging and Analysis Center; Duke University School of Medicine; Durham NC USA
| | - Brett Froeliger
- Neuroscience Department; Medical University of South Carolina; Charleston SC USA
| | - Jed E. Rose
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
| | - Rachel V. Kozink
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
| | - Merideth A. Addicott
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
- Duke-UNC Brain Imaging and Analysis Center; Duke University School of Medicine; Durham NC USA
| | - Maggie M. Sweitzer
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
| | - Eric C. Westman
- Department of Medicine; Duke University School of Medicine; Durham NC USA
| | - Dana M. Van Wert
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
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32
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Calcott P, Petkov V. Corrective Taxes and Cigarette Characteristics. HEALTH ECONOMICS 2016; 25:844-859. [PMID: 25919448 DOI: 10.1002/hec.3188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 10/03/2014] [Accepted: 03/30/2015] [Indexed: 06/04/2023]
Abstract
If cigarette design was exogenous, inefficiencies arising from smoking could be addressed either with a tax per packet or with an ad valorem tax. However, it is well known that the consequences of these two instruments differ when product characteristics are endogenous. We consider three such characteristics: nicotine, tar, and flavor. Implementation of the first-best social optimum typically requires the capacity to tax or regulate harmful ingredients. Without such a capacity, the next-best policy often combines a per-unit tax on cigarettes with an ad valorem subsidy. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paul Calcott
- School of Economics and Finance, Victoria University of Wellington, Wellington, New Zealand
| | - Vladimir Petkov
- School of Economics and Finance, Victoria University of Wellington, Wellington, New Zealand
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Perkins KA, Kunkle N, Karelitz JL, Michael VC, Donny EC. Threshold dose for discrimination of nicotine via cigarette smoking. Psychopharmacology (Berl) 2016; 233:2309-17. [PMID: 27037937 PMCID: PMC4873331 DOI: 10.1007/s00213-016-4281-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/17/2016] [Indexed: 12/28/2022]
Abstract
RATIONALE The lowest nicotine threshold "dose" in cigarettes discriminated from a cigarette containing virtually no nicotine may help inform the minimum dose maintaining dependence. OBJECTIVES Spectrum research cigarettes (from NIDA) differing in nicotine content were used to evaluate a procedure to determine discrimination thresholds. METHODS Dependent smokers (n = 18; 13 M, 5 F) were tested on ability to discriminate cigarettes with nicotine contents of 11, 5, 2.4, and 1.3 mg/g, one per session, from the "ultralow" cigarette with 0.4 mg/g, after having discriminated 16 mg/g from 0.4 mg/g (all had 9-10 mg "tar"). Exposure to each was limited to 4 puffs/trial. All subjects were abstinent from smoking overnight prior to each session, and the number of sessions was determined by the participant's success in discrimination behavior on >80 % of trials. Subjective perceptions and behavioral choice between cigarettes were also assessed and related to discrimination behavior. RESULTS The median threshold was 11 mg/g, but the range was 2.4 to 16 mg/g, suggesting wide variability in discrimination threshold. Compared to the ultralow, puff choice was greater for the subject's threshold dose but only marginal for the subthreshold (next lowest nicotine) cigarette. Threshold and subthreshold also differed on subjective perceptions but not withdrawal relief. CONCLUSIONS Under these testing conditions, threshold content for discriminating nicotine via cigarettes may be 11 mg/g or greater for most smokers, but some can discriminate nicotine contents one-half or one-quarter this amount. Further study with other procedures and cigarette exposure amounts may identify systematic differences in nicotine discrimination thresholds.
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Affiliation(s)
- Kenneth A Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Nicole Kunkle
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Joshua L Karelitz
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Valerie C Michael
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, 210 S. Bouquet St., Pittsburgh, PA, 15260, USA
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Desai RI, Doyle MR, Withey SL, Bergman J. Nicotinic effects of tobacco smoke constituents in nonhuman primates. Psychopharmacology (Berl) 2016; 233:1779-89. [PMID: 26892379 DOI: 10.1007/s00213-016-4238-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/04/2016] [Indexed: 12/25/2022]
Abstract
RATIONALE Recent studies in rodents suggest that non-nicotine constituents of tobacco smoke (e.g., minor tobacco alkaloids) may promote tobacco consumption-either through their own pharmacological effects or by augmenting the effects of nicotine. However, there is scant information on the behavioral pharmacology of minor tobacco alkaloids in primate species. OBJECTIVE The present studies were conducted to determine whether the minor tobacco alkaloids nornicotine, anabasine, anatabine, myosmine, and cotinine exhibit nicotine-like behavioral effects in squirrel monkeys. METHODS Initial experiments were conducted to determine the effects of nicotine (0.032-1.0 mg/kg) and the minor tobacco alkaloids nornicotine (1-1.8 mg/kg), anabasine (0.1-1.0 mg/kg), anatabine (10-32 mg/kg), myosmine (0.32-1.8 mg/kg), and cotinine (10-180 mg/kg) on food-maintained performance (n = 4). Next, the ability of tobacco alkaloids to substitute for the α4β2-selective nicotinic agonist (+)-epibatidine in drug discrimination experiments was evaluated in a separate group of monkeys (n = 4). RESULTS Results show that nicotine and each minor tobacco alkaloid except cotinine (a) produced dose-related decreases in food-maintained responding; (b) substituted for (+)-epibatidine and, in additional experiments, produced additive effects when combined with nicotine; (c) induced emesis or tremor at doses that reduced food-maintained responding and had (+)-epibatidine-like discriminative-stimulus effects; and (d) based on correlation with reported receptor binding affinities, likely produced their behavioral effects through α4β2 receptor mechanisms. CONCLUSION Selected minor tobacco alkaloids have nicotinic-like effects that may contribute to tobacco consumption and addiction.
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Affiliation(s)
- Rajeev I Desai
- Preclinical Pharmacology Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA.
| | - Michelle R Doyle
- Preclinical Pharmacology Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA
| | - Sarah L Withey
- Preclinical Pharmacology Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA
| | - Jack Bergman
- Preclinical Pharmacology Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA
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Big tobacco, E-cigarettes, and a road to the smoking endgame. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 29:14-8. [PMID: 26774225 DOI: 10.1016/j.drugpo.2015.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
Abstract
The provision of the extraordinarily deadly product of cigarettes is dominated by a small number of large and incredibly profitable shareholder owned companies that are focussed on cigarettes. The legal duty of their managers to maximise shareholder wealth means that such companies vigorously fight any new public health measures that have the potential to disrupt their massive profit making, and have the resources to do so. Protecting the public health is therefore made a lot more difficult and expensive. We suggest that one way to counter this would be to actively design future tobacco control policies so that tobacco companies face mechanisms and incentives to develop in such a way that they no longer achieve the greatest shareholder value by focusing on cigarettes. A proper tobacco diversification and exit strategy for the shareholders of the profit-seeking tobacco industry would protect the public health by addressing the current addiction to the continuation of the cigarette market. The increasing popularity of e-cigarettes presents a particular opportunity in this regard, and we therefore suggest a possible policy response in order to start discussion in this area.
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A Two-Day Continuous Nicotine Infusion Is Sufficient to Demonstrate Nicotine Withdrawal in Rats as Measured Using Intracranial Self-Stimulation. PLoS One 2015; 10:e0144553. [PMID: 26658557 PMCID: PMC4684239 DOI: 10.1371/journal.pone.0144553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/19/2015] [Indexed: 01/23/2023] Open
Abstract
Avoidance of the negative affective (emotional) symptoms of nicotine withdrawal (e.g., anhedonia, anxiety) contributes to tobacco addiction. Establishing the minimal nicotine exposure conditions required to demonstrate negative affective withdrawal signs in animals, as well as understanding moderators of these conditions, could inform tobacco addiction-related research, treatment, and policy. The goal of this study was to determine the minimal duration of continuous nicotine infusion required to demonstrate nicotine withdrawal in rats as measured by elevations in intracranial self-stimulation (ICSS) thresholds (anhedonia-like behavior). Administration of the nicotinic acetylcholine receptor antagonist mecamylamine (3.0 mg/kg, s.c.) on alternate test days throughout the course of a 2-week continuous nicotine infusion (3.2 mg/kg/day via osmotic minipump) elicited elevations in ICSS thresholds beginning on the second day of infusion. Magnitude of antagonist-precipitated withdrawal did not change with further nicotine exposure and mecamylamine injections, and was similar to that observed in a positive control group receiving mecamylamine following a 14-day nicotine infusion. Expression of a significant withdrawal effect was delayed in nicotine-infused rats receiving mecamylamine on all test days rather than on alternate test days. In a separate study, rats exhibited a transient increase in ICSS thresholds following cessation of a 2-day continuous nicotine infusion (3.2 mg/kg/day). Magnitude of this spontaneous withdrawal effect was similar to that observed in rats receiving a 9-day nicotine infusion. Our findings demonstrate that rats exhibit antagonist-precipitated and spontaneous nicotine withdrawal following a 2-day continuous nicotine infusion, at least under the experimental conditions studied here. Magnitude of these effects were similar to those observed in traditional models involving more prolonged nicotine exposure. Further development of these models, including evaluation of more clinically relevant nicotine dosing regimens and other measures of nicotine withdrawal (e.g., anxiety-like behavior, somatic signs), may be useful for understanding the development of the nicotine withdrawal syndrome.
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McDaniel PA, Smith EA, Malone RE. The tobacco endgame: a qualitative review and synthesis. Tob Control 2015; 25:594-604. [PMID: 26320149 PMCID: PMC5036259 DOI: 10.1136/tobaccocontrol-2015-052356] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/04/2015] [Indexed: 11/13/2022]
Abstract
The tobacco endgame concept reorients discussion away from the persistent control of tobacco toward plans for ending the tobacco epidemic, and envisions a tobacco-free future. A variety of policy approaches have been proposed, with many offered prior to the introduction of the unifying term ‘endgame’. We conducted a qualitative synthesis of the literature on tobacco control endgames, and drew on media accounts and discussion of analogous ideas for illustrative purposes. We identified proposals focused on the product, user, market/supply or larger institutional structures. Research on public support for these proposals was limited, but suggestive of some public appetite for endgame ideas. Advocates should be encouraged to explore new policy options and consider the goal of a tobacco-free future.
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Affiliation(s)
- Patricia A McDaniel
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
| | - Elizabeth A Smith
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
| | - Ruth E Malone
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
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Harris AC, Tally L, Muelken P, Banal A, Schmidt CE, Cao Q, LeSage MG. Effects of nicotine and minor tobacco alkaloids on intracranial-self-stimulation in rats. Drug Alcohol Depend 2015; 153:330-4. [PMID: 26094184 PMCID: PMC4509975 DOI: 10.1016/j.drugalcdep.2015.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND While nicotine is the primary addictive compound in tobacco, other tobacco constituents including minor alkaloids (e.g., nornicotine, anabasine) may also contribute to tobacco addiction by mimicking or enhancing the effects of nicotine. Further evaluating the behavioral effects of minor alkaloids is essential for understanding their impact on tobacco addiction and informing development of tobacco product standards by the FDA. METHODS This study compared the addiction-related effects of nicotine and the minor alkaloids nornicotine, anabasine, myosmine, anatabine, and cotinine on intracranial self-stimulation (ICSS) thresholds in rats. RESULTS Acute injection of nicotine produced reinforcement-enhancing (ICSS threshold-decreasing) effects at low to moderate doses, and reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at high doses. Nornicotine and anabasine produced similar biphasic effects on ICSS thresholds, although with lower potency compared to nicotine. Myosmine only elevated ICSS thresholds at relatively high doses, while anatabine and cotinine did not influence ICSS thresholds at any dose. None of the alkaloids significantly influenced ICSS response latencies, indicating a lack of nonspecific motoric effects. CONCLUSIONS These findings indicate that some minor tobacco alkaloids can either fully (nornicotine, anabasine) or partially (myosmine) mimic nicotine's addiction-related effects on ICSS, albeit at reduced potency. These findings emphasize the need for further study of the abuse potential of minor alkaloids, including evaluation of their effects when combined with nicotine and other tobacco constituents to better simulate tobacco exposure in humans. Such work is essential for informing FDA regulation of tobacco products and could also lead to the development of novel pharmacotherapies for tobacco addiction.
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Affiliation(s)
- Andrew C. Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Laura Tally
- Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Peter Muelken
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Ecology, Evolution, and Behavior, University of Minnesota, Minneapolis, MN
| | - Andrew Banal
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Clare E. Schmidt
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Neuroscience, University of Minnesota, Minneapolis, MN
| | - Qing Cao
- Masonic Cancer Center Biostatistics and Bioinformatics Core, University of Minnesota, Minneapolis, MN
| | - Mark G. LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN
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Gaalema DE, Miller ME, Tidey JW. Predicted Impact of Nicotine Reduction on Smokers with Affective Disorders. TOB REGUL SCI 2015; 1:154-165. [PMID: 26236765 PMCID: PMC4517852 DOI: 10.18001/trs.1.2.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In 2009 the FDA acquired the authority to reduce the nicotine content in cigarettes if appropriate for public health, prompting research to evaluate the implications of this policy scientifically. Studies in non-psychiatric populations show that reducing the nicotine content of cigarettes to non-addictive levels reduces smoking rates and nicotine dependence. However, few studies have examined this hypothesis in vulnerable populations. METHODS In this narrative review we examined the extant literature on the effects of nicotine reduction or cessation on symptoms of withdrawal, as well as psychiatric symptoms, among those with affective disorders. RESULTS Following initial withdrawal from nicotine, smokers with affective disorders experience more severe mood disruption than smokers without these disorders. Use of very low nicotine content (VLNC) cigarettes during abstinence may help mitigate the mood-disrupting effects of initial abstinence. Once the initial effects of nicotine withdrawal on mood have passed, longer-term abstinence is associated with psychiatric improvement rather than worsening. CONCLUSIONS These findings suggest that if a national nicotine reduction policy were to be implemented, smokers with affective disorders would need additional support to overcome initial withdrawal but that long-term outcomes would likely be positive.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center of Behavior and Health, University of Vermont, Burlington VT
| | - Mollie E Miller
- Center for Alcohol and Addictions Studies, Brown University, Providence RI
| | - Jennifer W Tidey
- Center for Alcohol and Addictions Studies, Brown University, Providence RI
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Gathuru IM, Tarter RE, Klein-Fedyshin M. Review of hookah tobacco smoking among college students: policy implications and research recommendations. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:272-80. [PMID: 26057153 DOI: 10.3109/00952990.2015.1043738] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco. OBJECTIVE Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy. METHODS PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy". RESULTS Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking. CONCLUSION Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.
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Grebenstein PE, Burroughs D, Roiko SA, Pentel PR, LeSage MG. Predictors of the nicotine reinforcement threshold, compensation, and elasticity of demand in a rodent model of nicotine reduction policy. Drug Alcohol Depend 2015; 151:181-93. [PMID: 25891231 PMCID: PMC4447604 DOI: 10.1016/j.drugalcdep.2015.03.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The FDA is considering reducing the nicotine content in tobacco products as a population-based strategy to reduce tobacco addiction. Research is needed to determine the threshold level of nicotine needed to maintain smoking and the extent of compensatory smoking that could occur during nicotine reduction. Sources of variability in these measures across sub-populations also need to be identified so that policies can take into account the risks and benefits of nicotine reduction in vulnerable populations. METHODS The present study examined these issues in a rodent nicotine self-administration model of nicotine reduction policy to characterize individual differences in nicotine reinforcement thresholds, degree of compensation, and elasticity of demand during progressive reduction of the unit nicotine dose. The ability of individual differences in baseline nicotine intake and nicotine pharmacokinetics to predict responses to dose reduction was also examined. RESULTS Considerable variability in the reinforcement threshold, compensation, and elasticity of demand was evident. High baseline nicotine intake was not correlated with the reinforcement threshold, but predicted less compensation and less elastic demand. Higher nicotine clearance predicted low reinforcement thresholds, greater compensation, and less elastic demand. Less elastic demand also predicted lower reinforcement thresholds. CONCLUSIONS These findings suggest that baseline nicotine intake, nicotine clearance, and the essential value of nicotine (i.e. elasticity of demand) moderate the effects of progressive nicotine reduction in rats and warrant further study in humans. They also suggest that smokers with fast nicotine metabolism may be more vulnerable to the risks of nicotine reduction.
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Affiliation(s)
- Patricia E. Grebenstein
- Department of Medicine, Minneapolis Medical Research Foundation, 701 Park Ave., Minneapolis, MN, 55415,Department of Medicine, University of Minnesota School of Medicine, 420 Delaware St. SE Minneapolis, MN, 55455
| | - Danielle Burroughs
- Department of Medicine, Minneapolis Medical Research Foundation, 701 Park Ave., Minneapolis, MN, 55415
| | - Samuel A. Roiko
- Department of Neuroscience, Gillette Children’s Specialty Healthcare, 183 University Ave E Saint Paul, MN 55101
| | - Paul R. Pentel
- Department of Medicine, Minneapolis Medical Research Foundation, 701 Park Ave., Minneapolis, MN, 55415,Department of Medicine, University of Minnesota School of Medicine, 420 Delaware St. SE Minneapolis, MN, 55455,Department of Pharmacology, University of Minnesota School of Medicine, 6-120 Jackson Hall, 321 Church St. SE, Minneapolis, MN, 55455
| | - Mark G. LeSage
- Department of Medicine, Minneapolis Medical Research Foundation, 701 Park Ave., Minneapolis, MN, 55415,Department of Medicine, University of Minnesota School of Medicine, 420 Delaware St. SE Minneapolis, MN, 55455,Department of Psychology, University of Minnesota, N218 Elliot Hall, 75 E River Rd., Minneapolis, MN, 55455
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Perkins KA, Karelitz JL. Sex differences in acute relief of abstinence-induced withdrawal and negative affect due to nicotine content in cigarettes. Nicotine Tob Res 2015; 17:443-8. [PMID: 25762754 PMCID: PMC4425834 DOI: 10.1093/ntr/ntu150] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/24/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Acute cigarette smoking may relieve withdrawal and negative affect due to tobacco abstinence to a greater extent in women versus men. Yet, the relative contribution of the cigarette's nicotine content to this sex difference is not clear. METHODS Non-quitting dependent adult smokers (N = 44; 21 males, 23 females) participated in 2 virtually identical sessions, each after abstaining overnight (CO < 10 ppm) and differing only in the nicotine content of the designated cigarette. While blind to brand markings, they consumed a total of 24 puffs in controlled fashion for 2 hr in each session, either from a nicotine (Quest 1, 0.6 mg) or denicotinized (Quest 3, 0.05 mg) cigarette. Withdrawal symptoms were obtained before and after smoking, and negative affect was assessed after each period of cigarette exposure consisting of 6 puffs every 25 min. RESULTS Men and women did not differ in baseline withdrawal and negative affect due to overnight abstinence, but reductions in each symptom were significantly influenced by the interaction of sex × nicotine/denicotinized cigarette (both p < .05). In men, but not in women, each symptom was generally decreased more by the nicotine versus denicotinized cigarette, and the nicotine cigarette reduced each to a greater degree in men versus women. CONCLUSIONS Sex differences in relief of abstinence-induced withdrawal and negative affect due to the nicotine content in cigarettes are consistent with prior research indicating that nicotine per se, compared to non-nicotine smoke stimuli, is less rewarding in women versus men.
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Lewis RS, Lopez HO, Bowen SW, Andres KR, Steede WT, Dewey RE. Transgenic and mutation-based suppression of a berberine bridge enzyme-like (BBL) gene family reduces alkaloid content in field-grown tobacco. PLoS One 2015; 10:e0117273. [PMID: 25688975 PMCID: PMC4331498 DOI: 10.1371/journal.pone.0117273] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/22/2014] [Indexed: 12/05/2022] Open
Abstract
Motivation exists to develop tobacco cultivars with reduced nicotine content for the purpose of facilitating compliance with expected tobacco product regulations that could mandate the lowering of nicotine levels per se, or the reduction of carcinogenic alkaloid-derived tobacco specific nitrosamines (TSNAs). A berberine bridge enzyme-like (BBL) gene family was recently characterized for N. tabacum and found to catalyze one of the final steps in pyridine alkaloid synthesis for this species. Because this gene family acts downstream in the nicotine biosynthetic pathway, it may represent an attractive target for genetic strategies with the objective of reducing alkaloid content in field-grown tobacco. In this research, we produced transgenic doubled haploid lines of tobacco cultivar K326 carrying an RNAi construct designed to reduce expression of the BBL gene family. Field-grown transgenic lines carrying functional RNAi constructs exhibited average cured leaf nicotine levels of 0.684%, in comparison to 2.454% for the untransformed control. Since numerous barriers would need to be overcome to commercialize transgenic tobacco cultivars, we subsequently pursued a mutation breeding approach to identify EMS-induced mutations in the three most highly expressed isoforms of the BBL gene family. Field evaluation of individuals possessing different homozygous combinations of truncation mutations in BBLa, BBLb, and BBLc indicated that a range of alkaloid phenotypes could be produced, with the triple homozygous knockout genotype exhibiting greater than a 13-fold reduction in percent total alkaloids. The novel source of genetic variability described here may be useful in future tobacco breeding for varied alkaloid levels.
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Affiliation(s)
- Ramsey S. Lewis
- Department of Crop Science, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Harry O. Lopez
- Department of Crop Science, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Steve W. Bowen
- Department of Crop Science, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Karen R. Andres
- Department of Crop Science, North Carolina State University, Raleigh, North Carolina, United States of America
| | - William T. Steede
- Department of Crop Science, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Ralph E. Dewey
- Department of Crop Science, North Carolina State University, Raleigh, North Carolina, United States of America
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Harris AC, Tally L, Schmidt CE, Muelken P, Stepanov I, Saha S, Vogel RI, LeSage MG. Animal models to assess the abuse liability of tobacco products: effects of smokeless tobacco extracts on intracranial self-stimulation. Drug Alcohol Depend 2015; 147:60-7. [PMID: 25561387 PMCID: PMC4337227 DOI: 10.1016/j.drugalcdep.2014.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/12/2014] [Accepted: 12/11/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preclinical models are needed to inform regulation of tobacco products by the Food and Drug Administration (FDA). Typically, animal models of tobacco addiction involve exposure to nicotine alone or nicotine combined with isolated tobacco constituents (e.g. minor alkaloids). The goal of this study was to develop a model using extracts derived from tobacco products that contain a range of tobacco constituents to more closely model product exposure in humans. METHODS This study compared the addiction-related effects of nicotine alone and nicotine dose-equivalent concentrations of aqueous smokeless tobacco extracts on intracranial self-stimulation (ICSS) in rats. Extracts were prepared from Kodiak Wintergreen, a conventional product, or Camel Snus, a potential "modified risk tobacco product". Binding affinities of nicotine alone and extracts at various nicotinic acetylcholine receptor (nAChR) subtypes were also compared. RESULTS Kodiak and Camel Snus extracts contained levels of minor alkaloids within the range of those shown to enhance nicotine's behavioral effects when studied in isolation. Nonetheless, acute injection of both extracts produced reinforcement-enhancing (ICSS threshold-decreasing) effects similar to those of nicotine alone at low to moderate nicotine doses, as well as similar reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at high nicotine doses. Extracts and nicotine alone also had similar binding affinity at all nAChRs studied. CONCLUSIONS Relative nicotine content is the primary pharmacological determinant of the abuse liability of Kodiak and Camel Snus as measured using ICSS. These models may be useful to compare the relative abuse liability of other tobacco products and to model FDA-mandated changes in product performance standards.
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Affiliation(s)
- Andrew C Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Laura Tally
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Clare E Schmidt
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Peter Muelken
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Ecology, Evolution, and Behavior, University of Minnesota, Minneapolis, MN, USA
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Subhrakanti Saha
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Isaksson Vogel
- Masonic Cancer Center, Biostatistics and Bioinformatics Core, University of Minnesota Minneapolis, MN, USA
| | - Mark G LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Smith TT, Sved AF, Hatsukami DK, Donny EC. Nicotine reduction as an increase in the unit price of cigarettes: a behavioral economics approach. Prev Med 2014; 68:23-8. [PMID: 25025523 PMCID: PMC4446706 DOI: 10.1016/j.ypmed.2014.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/04/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
Urgent action is needed to reduce the harm caused by smoking. Product standards that reduce the addictiveness of cigarettes are now possible both in the U.S. and in countries party to the Framework Convention on Tobacco Control. Specifically, standards that required substantially reduced nicotine content in cigarettes could enable cessation in smokers and prevent future smoking among current non-smokers. Behavioral economics uses principles from the field of microeconomics to characterize how consumption of a reinforcer changes as a function of the unit price of that reinforcer (unit price=cost/reinforcer magnitude). A nicotine reduction policy might be considered an increase in the unit price of nicotine because smokers are paying more per unit of nicotine. This perspective allows principles from behavioral economics to be applied to nicotine reduction research questions, including how nicotine consumption, smoking behavior, use of other tobacco products, and use of other drugs of abuse are likely to be affected. This paper reviews the utility of this approach and evaluates the notion that a reduction in nicotine content is equivalent to a reduction in the reinforcement value of smoking-an assumption made by the unit price approach.
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Affiliation(s)
- Tracy T Smith
- Department of Psychology, University of Pittsburgh, USA.
| | - Alan F Sved
- Department of Psychology, University of Pittsburgh, USA; Department of Neuroscience, University of Pittsburgh, USA
| | | | - Eric C Donny
- Department of Psychology, University of Pittsburgh, USA.
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Donny EC, Hatsukami DK, Benowitz NL, Sved AF, Tidey JW, Cassidy RN. Reduced nicotine product standards for combustible tobacco: building an empirical basis for effective regulation. Prev Med 2014; 68:17-22. [PMID: 24967958 PMCID: PMC4253911 DOI: 10.1016/j.ypmed.2014.06.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/21/2014] [Accepted: 06/15/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Both the Tobacco Control Act in the U.S. and Article 9 of the Framework Convention on Tobacco Control enable governments to directly address the addictiveness of combustible tobacco by reducing nicotine through product standards. Although nicotine may have some harmful effects, the detrimental health effects of smoked tobacco are primarily due to non-nicotine constituents. Hence, the health effects of nicotine reduction would likely be determined by changes in behavior that result in changes in smoke exposure. METHODS Herein, we review the current evidence on nicotine reduction and discuss some of the challenges in establishing the empirical basis for regulatory decisions. RESULTS To date, research suggests that very low nicotine content cigarettes produce a desirable set of outcomes, including reduced exposure to nicotine, reduced smoking, and reduced dependence, without significant safety concerns. However, much is still unknown, including the effects of gradual versus abrupt changes in nicotine content, effects in vulnerable populations, and impact on youth. DISCUSSION A coordinated effort must be made to provide the best possible scientific basis for regulatory decisions. The outcome of this effort may provide the foundation for a novel approach to tobacco control that dramatically reduces the devastating health consequences of smoked tobacco.
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Affiliation(s)
- Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Dorothy K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55414, USA
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alan F Sved
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Jennifer W Tidey
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Rachel N Cassidy
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI 02912, USA
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Dermody SS, Donny EC, Hertsgaard LA, Hatsukami DK. Greater reductions in nicotine exposure while smoking very low nicotine content cigarettes predict smoking cessation. Tob Control 2014; 24:536-9. [PMID: 25192771 DOI: 10.1136/tobaccocontrol-2014-051797] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/20/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Reducing the nicotine content of cigarettes is a potential regulatory strategy that may enable cessation. The present study investigated the effect of nicotine exposure while smoking very low nicotine content (VLNC) cigarettes on cessation outcomes. The roles of possible sources of nicotine were also explored, including the VLNC cigarette and co-use of cigarettes with normal nicotine content. METHODS A secondary data analysis of two analogous randomised trials of treatment seeking, adult daily smokers (n=112) who were instructed to smoke VLNC cigarettes for 6 weeks and then make a quit attempt. Controlling for baseline demographic and smoking features, the association between reductions in nicotine exposure during the 6-week trial, assessed by urinary total cotinine and biomarker-confirmed smoking abstinence 1 month later, was tested. Subsequent analyses controlled for the effects of the frequency of VLNC and normal nicotine content cigarette use and the nicotine yield of the VLNC cigarette (0.05 vs 0.09 mg). RESULTS Greater reductions in nicotine exposure while smoking VLNC cigarettes predicted abstinence independent of individual differences in baseline smoking, cotinine, dependence, gender and study. Nicotine reduction was largest among individuals who were assigned to smoke a VLNC cigarette with lower nicotine yield and who smoked fewer normal nicotine content and VLNC cigarettes. CONCLUSIONS In the context of nicotine regulations and corresponding research, factors that undermine nicotine reduction must be addressed, including the availability and use of cigarettes with normal nicotine content and not sufficiently reducing the nicotine yield of cigarettes. Maximising nicotine reduction may facilitate smoking cessation. TRIAL REGISTRATION NUMBERS NCT 01050569 and NCT 00777569.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Louise A Hertsgaard
- Tobacco Research Programs, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dorothy K Hatsukami
- Tobacco Research Programs, University of Minnesota, Minneapolis, Minnesota, USA Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
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De Biasi M, McLaughlin I, Perez EE, Crooks PA, Dwoskin LP, Bardo MT, Pentel PR, Hatsukami D. Scientific overview: 2013 BBC plenary symposium on tobacco addiction. Drug Alcohol Depend 2014; 141:107-17. [PMID: 24934691 PMCID: PMC4227301 DOI: 10.1016/j.drugalcdep.2014.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 12/13/2022]
Abstract
Nicotine dependence plays a critical role in addiction to tobacco products, and thus contributes to a variety of devastating tobacco-related diseases (SGR 2014). Annual costs associated with smoking in the US are estimated to be between $289 and $333 billion. Effective interventions for nicotine dependence, especially in smokers, are a critical barrier to the eradication of tobacco-related diseases. This overview highlights research presented at the Plenary Symposium of Behavior, Biology and Chemistry: Translational Research in Addiction Conference (BBC), hosted by the UT Health Science Center San Antonio, on March 9-10, 2013. The Plenary Symposium focused on tobacco addiction, and covered topics ranging from basic science to national policy. As in previous years, the meeting brought together globally-renowned scientists, graduate student recruits, and young scientists from underrepresented populations in Texas and other states with the goal of fostering interest in drug addiction research in young generations.
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Affiliation(s)
- M De Biasi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
| | - I McLaughlin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E E Perez
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - P A Crooks
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L P Dwoskin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - M T Bardo
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - P R Pentel
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - D Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Vogel RI, Hertsgaard LA, Dermody SS, Luo X, Moua L, Allen S, al'Absi M, Hatsukami DK. Sex differences in response to reduced nicotine content cigarettes. Addict Behav 2014; 39:1197-204. [PMID: 24746485 DOI: 10.1016/j.addbeh.2014.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/19/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND When switching from usual brand cigarettes, very low nicotine content (VLNC) cigarettes lead to a reduction in the number of cigarettes smoked, toxicant exposure, withdrawal symptoms and dependence. One area that has been relatively unexplored is what factors might moderate the effects of VLNC cigarettes. This exploratory analysis focuses on sex differences in responses to VLNC cigarettes and nicotine replacement therapy. METHODS An exploratory secondary analysis of a randomized trial of 235 participants (58% female, mean age 47 years) comparing a) 0.05-0.09 mg nicotine yield cigarettes; b) 21 mg nicotine patch and 3) 0.05-0.09 nicotine yield cigarettes with 21 mg nicotine patch was conducted. We focused on sex differences in product use, and impact of products on withdrawal response from usual brand cigarettes and abstinence by randomized group. RESULTS The combination of VLNC cigarettes and nicotine patch was more effective in reducing use of VLNC cigarettes and withdrawal symptoms among males than females, whereas females were equally responsive to VLNC cigarettes with and without the nicotine patch. Females were more likely to quit smoking than males when assigned to either of the conditions that incorporated the VLNC cigarettes; however, males were more likely to quit smoking in the nicotine patch alone condition than females. CONCLUSION Sex of the smoker may be an important determinant for effects of VLNC cigarettes and nicotine patch. Future large randomized trials to confirm these results are needed.
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Dermody SS, Donny EC. The predicted impact of reducing the nicotine content in cigarettes on alcohol use. Nicotine Tob Res 2014; 16:1033-44. [PMID: 24647051 DOI: 10.1093/ntr/ntu037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Product standards reducing the level of nicotine in cigarettes could significantly improve public health by reducing smoking behavior and toxicant exposure. However, relatively little is known about how the regulatory strategy could impact alcohol use, a closely related health behavior that is also a major contributor to morbidity and mortality. The primary objective of this paper is to predict the effect of nicotine reduction on alcohol use, identify priorities for future research, and highlight areas for mitigating any adverse outcomes. METHODS We critically reviewed and integrated literatures examining the effects of very low nicotine content (VLNC) cigarettes on smoking-related outcomes (nicotine exposure, nicotine withdrawal, and smoking as a cue to drink) and, in turn, the effects of those outcomes on alcohol use. RESULTS Current evidence suggests reducing the nicotine content of cigarettes may benefit public health by reducing alcohol use and problematic drinking over time as a consequence of reduced exposure to nicotine and the smoking cues associated with drinking. Nicotine withdrawal could increase risk of drinking, although these effects should be short-lived and could be mitigated by other sources of nicotine. Gender, hazardous drinking, and psychiatric comorbidities are likely to be important moderators of the effects of VLNC cigarettes. CONCLUSIONS It is imperative to broadly assess the public health impact of potential tobacco product regulations by including measures of closely related health behaviors that could be impacted by these interventions. Nicotine reduction in cigarettes may contribute to improved public health through reductions in alcohol use.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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