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Giummo R, Oliver JA, McClernon FJ, Sweitzer MM. Associations between compliance with very low nicotine content (VLNC) cigarettes, abstinence self-efficacy, and quit outcomes in a pilot smoking cessation trial. Drug Alcohol Depend 2024; 262:111393. [PMID: 39024797 PMCID: PMC11360067 DOI: 10.1016/j.drugalcdep.2024.111393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/04/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Switching to Very Low Nicotine Content (VLNC) cigarettes reduces toxicant exposure and nicotine dependence, and may improve smoking cessation. However, non-compliance with VLNCs is often high, which may reduce their effectiveness. Here, we conducted secondary analyses of a pilot smoking cessation trial utilizing VLNCs to examine associations between pre-cessation VLNC compliance and changes in smoking rate, dependence, and abstinence self-efficacy, as well as quit outcomes. METHODS People who smoke daily (n=35) engaged in a 4-week pre-cessation intervention including VLNCs, transdermal nicotine patch, and behavioral counseling. After quit date, participants received 8 weeks of nicotine replacement therapy and 4 additional behavioral sessions, and were followed for 10 weeks to assess abstinence. Compliance with VLNCs was assessed biweekly during pre-cessation using timeline follow-back. Statistical analyses examined associations between VLNC compliance and a) changes in smoking rate, dependence and abstinence self-efficacy over the course of study cigarette use; and b) time to relapse, controlling for other smoking variables. RESULTS Greater compliance during the second half of study cigarette use was associated with subsequent improvement in self-efficacy (p<.05). Increased self-efficacy and VLNC compliance both predicted lower likelihood of relapse. Nicotine dependence and cigarettes per day both decreased following study cigarette use, but were unrelated to compliance or relapse. CONCLUSIONS Compliance with VLNCs prior to quitting increased abstinence self-efficacy and predicted better quit outcomes above and beyond baseline smoking characteristics. Although preliminary, these findings suggest that identifying strategies to promote exclusive use of VLNCs during a brief pre-cessation window may be beneficial.
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Affiliation(s)
- Ryann Giummo
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - Jason A Oliver
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - F Joseph McClernon
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - Maggie M Sweitzer
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA.
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Hahn B, Holzel ES. Nicotine insensitivity and cue-controlled smoking behavior in people with schizophrenia. Schizophr Res 2023; 262:51-52. [PMID: 37922844 PMCID: PMC11108591 DOI: 10.1016/j.schres.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/25/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Britta Hahn
- University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21224, Baltimore, MD 21228, United States.
| | - Elie S Holzel
- University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21224, Baltimore, MD 21228, United States
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Podlasek A, Claire R, Campbell KA, Orton S, Thomson R, Coleman T. Systematic review and meta-analysis investigating nicotine, cotinine and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy. Addiction 2023; 118:2076-2092. [PMID: 37394704 DOI: 10.1111/add.16279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
AIMS To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid and exhaled air carbon monoxide (CO) concentrations. METHODS Systematic review and meta-analysis of RCTs, which test interventions permitting concurrent NRT use and smoking and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. Measurements included reported number of cigarettes smoked per day (CPD), body fluid cotinine and expired air CO concentrations. RESULTS Twenty-nine studies were included in the review. Meta-analysis of nine showed that, compared with when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% CI = -3.06 to -1.07, P < 0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT used in the lead-up to quitting (i.e. as preloading), a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Eleven studies reported cotinine concentrations, but meta-analysis was not possible because of data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT use and smoking, four reported no differences, and none reported higher concentrations. CONCLUSIONS People who smoke and also use nicotine replacement therapy report smoking less heavily than people who solely smoke. When nicotine replacement therapy is used in the lead-up to quitting (preloading), this reported smoking reduction has been biochemically confirmed. There is no evidence that concurrent smoking and nicotine replacement therapy use result in greater nicotine exposure than solely smoking.
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Affiliation(s)
- Anna Podlasek
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
- Tayside Innovation and MedTech Ecosystem (TIME), University of Dundee, Dundee, Scotland, UK
| | - Ravinder Claire
- National Institute for Health and Care Excellence, London, London City, UK
| | - Katarzyna A Campbell
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Sophie Orton
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Ross Thomson
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
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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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Part three: a randomized study to assess biomarker changes in cigarette smokers switched to Vuse Solo or Abstinence. Sci Rep 2022; 12:20658. [PMID: 36450821 PMCID: PMC9712618 DOI: 10.1038/s41598-022-25054-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Biomarkers of exposure (BoE) can help evaluate exposure to combustion-related, tobacco-specific toxicants after smokers switch from cigarettes to potentially less-harmful products like electronic nicotine delivery systems (ENDS). This paper reports data for one (Vuse Solo Original) of three products evaluated in a randomized, controlled, confinement study of BoE in smokers switched to ENDS. Subjects smoked their usual brand cigarette ad libitum for two days, then were randomized to one of three ENDS for a 7-day ad libitum use period, or to smoking abstinence. Thirteen BoE were assessed at baseline and Day 5, and percent change in mean values for each BoE was calculated. Biomarkers of potential harm (BoPH) linked to oxidative stress, platelet activation, and inflammation were also assessed. Levels decreased among subjects randomized to Vuse Solo versus Abstinence, respectively, for the following BoE: 42-96% versus 52-97% (non-nicotine constituents); 51% versus 55% (blood carboxyhemoglobin); and 29% versus 96% (nicotine exposure). Significant decreases were observed in three BoPH: leukotriene E4, 11-dehydro-thromboxane B2, and 2,3-dinor thromboxane B2 on Day 7 in the Vuse Solo and Abstinence groups. These findings show that ENDS use results in substantially reduced exposure to toxicants compared to smoking, which may lead to reduced biological effects.
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Wolf JM, Koopmeiners JS, Vock DM. A permutation procedure to detect heterogeneous treatments effects in randomized clinical trials while controlling the type I error rate. Clin Trials 2022; 19:512-521. [PMID: 35531765 DOI: 10.1177/17407745221095855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Secondary analyses of randomized clinical trials often seek to identify subgroups with differential treatment effects. These discoveries can help guide individual treatment decisions based on patient characteristics and identify populations for which additional treatments are needed. Traditional analyses require researchers to pre-specify potential subgroups to reduce the risk of reporting spurious results. There is a need for methods that can detect such subgroups without a priori specification while allowing researchers to control the probability of falsely detecting heterogeneous subgroups when treatment effects are uniform across the study population. METHODS We propose a permutation procedure for tuning parameter selection that allows for type I error control when testing for heterogeneous treatment effects framed within the Virtual Twins procedure for subgroup identification. We verify that the type I error rate can be controlled at the nominal rate and investigate the power for detecting heterogeneous effects when present through extensive simulation studies. We apply our method to a secondary analysis of data from a randomized trial of very low nicotine content cigarettes. RESULTS In the absence of type I error control, the observed type I error rate for Virtual Twins was between 99% and 100%. In contrast, models tuned via the proposed permutation were able to control the type I error rate and detect heterogeneous effects when present. An application of our approach to a recently completed trial of very low nicotine content cigarettes identified several variables with potentially heterogeneous treatment effects. CONCLUSIONS The proposed permutation procedure allows researchers to engage in secondary analyses of clinical trials for treatment effect heterogeneity while maintaining the type I error rate without pre-specifying subgroups.
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Affiliation(s)
- Jack M Wolf
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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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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Donny EC, White CM. A review of the evidence on cigarettes with reduced addictiveness potential. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103436. [PMID: 34535366 PMCID: PMC8785120 DOI: 10.1016/j.drugpo.2021.103436] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Hatsukami DK, Xu D, Ferris Wayne G. Regulatory approaches and implementation of minimally addictive combusted products. Nicotine Tob Res 2021; 24:453-462. [PMID: 34192324 DOI: 10.1093/ntr/ntab138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION A joint meeting was held by the World Health Organization (WHO) and the Convention Secretariat of the WHO Framework Convention on Tobacco Control to examine the potential effects of a regulatory policy to reduce nicotine in cigarettes to minimally addictive levels. This paper reviews the feasibility of and approaches to implementing a nicotine product standard. METHODS Prior WHO reports on this topic were consulted and a systematic review of the scientific literature was conducted. The paper was reviewed by the participants at the aforementioned meeting and their feedback was incorporated. RESULTS The nicotine dose most likely to consistently reduce smoking behavior and dependence is < 0.4 mg nicotine/g tobacco. An immediate rather than a gradual nicotine reduction approach appears to be more beneficial. Smokers are likely to seek nicotine from alternate sources (e.g., nicotine replacement therapies, e-cigarettes) or potentially, the illegal market. As such, the availability of alternative products, as well as strong policies against illegal markets, can potentially mitigate unintended consequences. An effective reduced nicotine regulation must be imbedded in a comprehensive and strong tobacco control program that includes public education and surveillance. Barriers and challenges to implementing a nicotine product standard exist, particularly in low-capacity countries. CONCLUSION Not all countries will have the capacity to implement a regulation to reduce nicotine in cigarettes (and preferably other combusted tobacco products) to minimally addictive levels. However, for the countries that choose to implement it, such a policy could potentially dramatically reduce the burden of tobacco use.
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Affiliation(s)
- Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Dongqun Xu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Denlinger-Apte RL, Pacek LR, Ross JC, Bansal-Travers M, Donny EC, Hatsukami DK, Carroll DM. Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5311. [PMID: 34067652 PMCID: PMC8156883 DOI: 10.3390/ijerph18105311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. METHODS Data are from Wave 4 (2016-2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents' absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. RESULTS The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were 'about the same' level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be 'about the same' harmfulness as medicinal nicotine. CONCLUSIONS Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity.
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Affiliation(s)
- Rachel L. Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (R.L.D.-A.); (J.C.R.)
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA;
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (R.L.D.-A.); (J.C.R.)
| | - Maansi Bansal-Travers
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Buffalo, NY 14263, USA;
| | - Eric C. Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Dorothy K. Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55414, USA;
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA
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Schlagintweit HE, Tyndale RF, Hendershot CS. Acute effects of a very low nicotine content cigarette on laboratory smoking lapse: Impacts of nicotine metabolism and nicotine dependence. Addict Biol 2021; 26:e12930. [PMID: 32573054 DOI: 10.1111/adb.12930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/29/2020] [Accepted: 05/31/2020] [Indexed: 12/13/2022]
Abstract
Reducing cigarette nicotine content to nonaddictive levels facilitates smoking cessation; however, very low nicotine content cigarettes (VLNCs) may not be equally effective across heterogeneous smokers. We evaluated the impact of acute VLNC smoking versus control (sham puffs) on craving, withdrawal and smoking lapse behaviour and whether genetically influenced differences in nicotine metabolism and individual differences in nicotine dependence moderate observed effects. Thirty-three overnight-abstinent smokers (15 slow vs. 17 normal nicotine metabolizers; 17 low vs. 16 high nicotine dependence) smoked a 0.05-mg nicotine VLNC during one session and took sham VLNC puffs during another session, in a counterbalanced order. Craving and withdrawal were assessed before and after smoking and sham puffing. Next, participants completed the McKee Smoking Lapse Task, which measures ability to resist smoking and quantity of ad libitum smoking. VLNC (vs. sham) reduced craving and withdrawal, increased ability to resist smoking and reduced ad libitum smoking. VLNC-induced reduction in craving for positive reinforcement was greater in slow (vs. normal) metabolizers. Nicotine metabolism did not moderate any other VLNC responses. High-dependence (vs. low-dependence) participants engaged in greater ad lib smoking across VLNC and sham conditions. Nicotine dependence did not moderate VLNC responses. VLNC reduced craving, withdrawal and smoking lapse behaviour. Individual differences in nicotine metabolism and dependence had a minimal impact on VLNC responses; however, VLNCs were less effective at reducing craving for positive reinforcement among normal (vs. slow) metabolizers. These findings suggest that desirable VLNC effects may extend across heterogeneous groups of smokers.
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Affiliation(s)
- Hera E. Schlagintweit
- Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health Toronto Ontario Canada
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health Toronto Ontario Canada
- Department of Pharmacology and Toxicology University of Toronto Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Christian S. Hendershot
- Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health Toronto Ontario Canada
- Department of Pharmacology and Toxicology University of Toronto Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
- Institute for Mental Health Policy Research Centre for Addiction and Mental Health Toronto Ontario Canada
- Department of Psychology University of Toronto Toronto Ontario Canada
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Karelitz JL, McClure EA, Wolford-Clevenger C, Pacek LR, Cropsey KL. Cessation classification likelihood increases with higher expired-air carbon monoxide cutoffs: a meta-analysis. Drug Alcohol Depend 2021; 221:108570. [PMID: 33592559 PMCID: PMC8026538 DOI: 10.1016/j.drugalcdep.2021.108570] [Citation(s) in RCA: 8] [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: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Expired-air carbon monoxide (CO) is commonly used to biochemically verify smoking status. The CO cutoff and CO monitor brand may affect the probability of classifying smokers as abstinent, thus influencing conclusions about the efficacy of cessation trials. No systematic reviews have tested this hypothesis. Therefore, we performed a meta-analysis examining whether the likelihood of smoking cessation classification varied due to CO cutoff and monitor brand. METHODS Eligible studies (k = 122) longitudinally assessed CO-verified cessation in adult smokers in randomized trials. Primary meta-regressions separately assessed differences in quit classification likelihood due to continuous and categorical CO cutoffs (Low, 3-4 parts per million [ppm]; [SRNT] Recommended, 5-6 ppm; Moderate, 7-8 ppm; and High, 9-10 ppm); exploratory analyses compared likelihood outcomes between monitor brands: Bedfont and Vitalograph. RESULTS The likelihood of quit classification increased 18% with each 1 ppm increase above the lowest cutoff (3 ppm). Odds of classification as quit significantly increased between each cutoff category and High: 261% increase from Low; 162% increase from Recommended; and 150% increase from Moderate. There were no differences in cessation classification between monitor brands. CONCLUSIONS As expected, higher CO cutoffs were associated with greater likelihood of cessation classification. The lack of CO monitor brand differences may have been due to model-level variance not able to be followed up in the present dataset. Researchers are advised to report outcomes using a range of cutoffs-including the recommended range (5-6 ppm)-and the CO monitor brand/model used. Using higher CO cutoffs significantly increases likelihood of quit classification, possibly artificially elevating treatment strategies.
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Affiliation(s)
- Joshua L Karelitz
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA.
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2068 Erwin Road, Room 3038, Durham, NC, 27705, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
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Streck JM, Sigmon SC, Priest J, Bergeria CL, Davis DR, Hughes JR, Villanti AC, Tidey JW, Heil SH, Gaalema DE, Stitzer ML, Higgins ST. Investigating tobacco withdrawal in response to reduced nicotine cigarettes among smokers with opioid use disorder and other vulnerabilities. Exp Clin Psychopharmacol 2020; 28:714-723. [PMID: 32027158 PMCID: PMC7415473 DOI: 10.1037/pha0000350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Kuiper N, Coats EM, Crawford TN, Gammon DG, Loomis B, Watson CH, Melstrom PC, Lavinghouze R, Rogers T, King BA. Trends in Manufacturer-Reported Nicotine Yields in Cigarettes Sold in the United States, 2013-2016. Prev Chronic Dis 2020; 17:E148. [PMID: 33241990 PMCID: PMC7735486 DOI: 10.5888/pcd17.200205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A gradual reduction of cigarette nicotine content to nonaddictive levels has been proposed as an endgame strategy to accelerate declines in combustible tobacco smoking. We assessed manufacturer-reported nicotine yield in cigarettes sold in the United States from 2013 to 2016. METHODS We merged machine-measured nicotine yield in cigarette smoke and pack characteristics obtained from reports filed by tobacco manufacturers with the Federal Trade Commission for 2013-2016 with monthly Nielsen data on US cigarette sales. Manufacturer-reported, sales-weighted, average annual nicotine yield was assessed, as were nicotine yield sales trends by quartile: markedly low (0.10-0.60 mg/stick), low (0.61-0.80 mg/stick), moderate (0.81-0.90 mg/stick), and high (0.91-3.00 mg/stick). Trends in overall, menthol, and nonmenthol pack sales, by nicotine yield quartiles over the study period and by year, were determined by using Joinpoint regression. RESULTS During 2013-2016, average annual sales-weighted nicotine yield for all cigarettes increased from 0.903 mg/stick (95% CI, 0.882-0.925) in 2013 to 0.938 mg/stick (95% CI, 0.915-0.962) in 2016 (P < .05). For menthol cigarettes, yield increased from 0.943 mg/stick in 2013 (95% CI, 0.909-0.977) to 1.037 mg/stick in 2016 (95% CI, 0.993-1.081), increasing 0.2% each month (P < .05). Most pack sales occurred among high (41.5%) and low (30.7%) nicotine yield quartiles. Cigarette sales for the markedly low quartile decreased by an average of 0.4% each month during 2013-2016 (P < .05). CONCLUSION During 2013-2016, manufacturer-reported, sales-weighted nicotine yield in cigarettes increased, most notably for menthol cigarettes. Continued monitoring of nicotine yield and content in cigarettes can inform tobacco control strategies.
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Affiliation(s)
- Nicole Kuiper
- Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341.
| | - Ellen M Coats
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina
| | - Tamara N Crawford
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Doris G Gammon
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina
| | - Brett Loomis
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina
| | - Clifford H Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul C Melstrom
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rene Lavinghouze
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Todd Rogers
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Higgins ST, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Lee D, Hughes JR, Villanti AC, Bunn JY, Davis DR, Bergeria CL, Streck JM, Parker MA, Miller ME, DeSarno M, Priest JS, Cioe P, MacLeod D, Barrows A, Markesich C, Harfmann RF. Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2019311. [PMID: 33079196 PMCID: PMC7576411 DOI: 10.1001/jamanetworkopen.2020.19311] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE This study is part of a programmatic effort evaluating the effects of reducing nicotine content of cigarettes to minimally addictive levels. OBJECTIVE To examine whether very low-nicotine-content (VLNC) cigarettes decrease smoking rates and dependence severity among smokers with psychiatric disorders or socioeconomic disadvantage. DESIGN, SETTING, AND PARTICIPANTS These 3 randomized clinical trials were performed at the University of Vermont, Brown University, and Johns Hopkins University between October 2016 and September 2019. Participants received 12 weeks of exposure to study cigarettes with nicotine content ranging from levels representative of commercial cigarettes (15.8 mg nicotine/g tobacco) to less than a hypothesized addiction threshold (2.4 mg/g and 0.4 mg/g). Daily smokers from 3 at-risk populations participated: individuals with affective disorders, exemplifying smokers with mental illness; individuals with opioid use disorder, exemplifying smokers with substance use disorders; and women with high school educations or less, exemplifying smokers with socioeconomic disadvantage. Data were analyzed from September 2019 to July 2020. INTERVENTIONS Random assignment to 1 of 3 study cigarettes provided weekly at no cost for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was between-group differences in mean total cigarettes smoked daily (CPD) during week 12; secondary outcomes included CPD for study and nonstudy cigarettes and dependence severity across weeks analyzed using analysis of covariance, random coefficients growth modeling, or repeated measures analysis of variance. RESULTS A total of 775 participants were included (mean [SD] age, 35.59 [11.05] years; 551 [71.10%] women [owing to 1 population being exclusively women]); participants smoked a mean (SD) of 17.79 (9.18) CPD at study intake. A total of 286 participants were randomized to 0.4 mg/g, 235 participants were randomized to 2.4 mg/g, and 254 participants were randomized to 15.8 mg/g. Participants randomized to VLNC cigarettes had decreased mean [SEM] total CPD during week 12 across populations (Cohen d = 0.61; P < .001). At week 12, mean (SEM) CPD decreased to 17.96 (0.98) CPD in the 0.4 mg/g group and to 19.53 (1.07) CPD in the 2.4 mg/g group, both of which were significantly different from the 15.8 mg/g group (25.08 [1.08] CPD at week 12) but not each other (0.4 mg/g adjusted mean difference: -7.54 [95%CI, -9.51 to -5.57]; 2.4 mg/g adjusted mean difference: -5.34 [95% CI, 7.41 to -3.26]). Several secondary outcomes differed across populations randomized to VLNCs, including mean total CPD across weeks, with linear trends lower in participants receiving 0.4 mg/g (-0.28 [95%CI, -0.39 to -0.18]; P < .001) and 2.4 mg/g (-0.13 [95%CI, -0.25 to -0.01]; P < .001) doses compared with those receiving the 15.8 mg/g dose (0.30 [95% CI, 0.19 to 0.41]). Fagerström Test of Nicotine Dependence mean total scores were significantly lower in participants who received VLNCs (Cohen d = 0.12; P < .001), with those who received the 0.4 mg/g dose (mean [SD] score, 3.99 [0.06]; P < .001 vs 15.8 mg/g) or 2.4 mg/g dose (mean [SD] score, 4.07 [0.06]; P = .01 vs 15.8 mg/g) differing from those who received the 15.8 mg/g dose (mean [SD] score, 4.31 [0.06]) but not from each other. CONCLUSIONS AND RELEVANCE These findings demonstrate that decreasing the nicotine content of cigarettes to very low levels reduced smoking rate and nicotine-dependence severity in these high-risk populations, effects that may facilitate successful cessation. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02232737, NCT02250664, NCT02250534.
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Affiliation(s)
- Stephen T. Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Stacey C. Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Sarah H. Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Diann E. Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Dustin Lee
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - John R. Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Andrea C. Villanti
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Janice Y. Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Danielle R. Davis
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - Cecilia L. Bergeria
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna M. Streck
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maria A. Parker
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- School of Public Health, Indiana University, Bloomington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Michael DeSarno
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jeff S. Priest
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Patricia Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Douglas MacLeod
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Anthony Barrows
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
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16
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Tai LC, Ahn CH, Nyein HYY, Ji W, Bariya M, Lin Y, Li L, Javey A. Nicotine Monitoring with a Wearable Sweat Band. ACS Sens 2020; 5:1831-1837. [PMID: 32429661 DOI: 10.1021/acssensors.0c00791] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The tobacco epidemic is a public health threat that has taken a heavy toll of lives around the globe each year. Smoking affects both the smokers and those who are exposed to secondhand smoke, and careful tracking of exposure can be key to mitigating the potential hazards. For smokers, the variation of chemical compositions between commercial cigarettes has led to ambiguity in estimating the health risks, both for active smokers and others involuntarily exposed to tobacco smoke and byproducts. In this regard, sweat possesses an attractive opportunity to monitor smoke exposure due to sweat's abundance in biomolecules and its great accessibility. Here, we present a wearable sweat band to monitor nicotine, a prominent ingredient in cigarettes, as a viable way to quantitatively assess a wearer's exposure to smoking. Both smokers and normal subjects are tested to demonstrate the use of this device for smoke-related health monitoring. Our results exhibit confirmable and elevated nicotine levels in sweat for subjects inhaling cigarette smoke. This continuous and personalized sweat sensing device is leverage to monitor smoke pollution for a potentially broad population.
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Affiliation(s)
- Li-Chia Tai
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Berkeley Sensor and Actuator Center, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Christine Heera Ahn
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
| | - Hnin Yin Yin Nyein
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Berkeley Sensor and Actuator Center, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Wenbo Ji
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Berkeley Sensor and Actuator Center, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Mallika Bariya
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Berkeley Sensor and Actuator Center, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Yuanjing Lin
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Berkeley Sensor and Actuator Center, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Lu Li
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Ali Javey
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California 94720, United States
- Berkeley Sensor and Actuator Center, University of California, Berkeley, California 94720, United States
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
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17
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Berman ML, Glasser AM. Nicotine Reduction in Cigarettes: Literature Review and Gap Analysis. Nicotine Tob Res 2020; 21:S133-S144. [PMID: 31867659 PMCID: PMC6939782 DOI: 10.1093/ntr/ntz162] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND The US Food and Drug Administration (FDA) is considering reducing nicotine levels in cigarettes to "minimally or non-addictive levels." However, important research gaps remain, and the FDA must determine when the available research is sufficient to support moving forward. METHODS The authors conducted a systematic review of research articles in PubMed relating to nicotine reduction. Building on a review of risk assessment best practices, the authors also developed a risk assessment framework for tobacco regulation and used it to guide a gap analysis of nicotine reduction research. RESULTS The final sample consisted of 78 articles. The majority examined either nicotine dependence on very low nicotine cigarettes (VLNCs) or markers of potential health effects of using VLNCs. One-third of the identified articles reported results from four large randomized controlled trials (RCTs). While these studies report promising results and suggest that a nicotine reduction rule would be a powerful tool to reduce cigarette smoking, our gap analysis suggests that there is a need for studies that better reflect the use and availability of a wide range of tobacco/nicotine products and the potential for dual- or multi-product use. CONCLUSION The current body of research on nicotine reduction is weighted towards RCTs, which is appropriate for a policy that has not yet been implemented anywhere in the world. The FDA must consider a wide range of factors that may impact a product standard's public health impact, including those difficult to assess in RCTs, such as a nicotine reduction rule's impact on smoking initiation and relapse. IMPLICATIONS This systematic review presents a gap analysis based on a risk assessment framework to help identify remaining research priorities to inform FDA's potential product standard to reduce nicotine levels in cigarettes. Quickly addressing those gaps would support the FDA's effort to develop a nicotine reduction product standard that will be effective and withstand legal challenges.
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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
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18
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Piper ME, Drobes DJ, Walker N. Behavioral and Subjective Effects of Reducing Nicotine in Cigarettes: A Cessation Commentary. Nicotine Tob Res 2020; 21:S19-S21. [PMID: 31867644 PMCID: PMC6939774 DOI: 10.1093/ntr/ntz100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/14/2019] [Indexed: 12/27/2022]
Abstract
This commentary addresses critical questions regarding the impact of the reduction of nicotine on changes in smoking behavior. There appears to be moderate evidence that use of reduced nicotine cigarettes (RNC) increases the likelihood of making a quit attempt among smokers unmotivated to quit and among smokers motivated to quit who also used nicotine replacement therapy (NRT). There was limited evidence that RNC combined with NRT increased smoking abstinence, regardless of motivation to quit. Several plausible mechanisms via which RNC may influence smoking behavior, including reducing dependence, are reviewed. The moderate evidence that abrupt reduction in nicotine reduces self-reported dependence as well as smoking behavior and likelihood of relapse is also reviewed. The data reviewed here suggest that abrupt switching to, and extended use of, RNC can reduce cigarette dependence and several related constructs, including the ability to quit smoking. The data reviewed in this commentary suggest that abrupt reduction in the level of nicotine in combustible cigarettes could reduce smoking behavior, nicotine dependence, and other related constructs and increase quit attempts and eventual smoking cessation.
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Affiliation(s)
- Megan E Piper
- Department of Medicine, School of Medicine and Public Health, Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI
| | - David J Drobes
- Tobacco Research and Intervention Program, Moffitt Cancer Center, Tampa, FL.,Departments of Oncologic Sciences & Psychology, University of South Florida, Tampa
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, New Zealand
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19
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Smith TT, Koopmeiners JS, White CM, Denlinger-Apte RL, Pacek LR, De Jesús VR, Wang L, Watson C, Blount BC, Hatsukami DK, Benowitz NL, Donny EC, Carpenter MJ. The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial. Cancer Epidemiol Biomarkers Prev 2020; 29:880-886. [PMID: 32102910 PMCID: PMC7125007 DOI: 10.1158/1055-9965.epi-19-0963] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/09/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The FDA is considering a mandated reduction in the nicotine content of cigarettes. Clinical trials have been limited by non-study cigarette use (noncompliance), which could mask compensation. The goal of this study was to assess whether compensation occurs when smokers provided with very low nicotine cigarettes cannot access normal nicotine cigarettes. METHODS In a within-subjects, crossover design, current smokers (n = 16) were confined to a hotel for two 4-night hotel stays during which they were only able to access the research cigarettes provided. The hotel stays offered normal nicotine cigarettes or very low nicotine content (VLNC) cigarettes, in an unblinded design, available for "purchase" via a study bank. RESULTS In the context of complete compliance with the study cigarettes (n = 16), there was not a significant increase during the VLNC condition for cigarettes smoked per day, expired carbon monoxide, or N-acetyl-S-(cyanoethyl)-l-cysteine (cyanoethyl-MA, metabolite of acrylonitrile). There was a significant nicotine × time interaction on urine N-acetyl-S-(3-hydroxypropyl)-l-cysteine (hydroxypropyl-MA, metabolite of acrolein), driven by an increase in the VLNC condition during the first 24 hours. By the end of the VLNC condition, there was no evidence of compensation across any measure of smoking or smoke exposure. CONCLUSIONS Among current smokers who exclusively used VLNC cigarettes for 4 days, there was no significant compensatory smoking behavior. IMPACT These data, combined with the larger body of work, suggest that a mandated reduction in nicotine content is unlikely to result in an increase in smoking behavior to obtain more nicotine.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Víctor R De Jesús
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clifford Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dorothy K Hatsukami
- Department of Psychiatry and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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20
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Smith TT, Koopmeiners JS, Hatsukami DK, Tessier KM, Benowitz NL, Murphy SE, Strasser AA, Tidey JW, Blount BC, Valentin L, Bravo Cardenas R, Watson C, Pirkle JL, Donny EC. Mouth-Level Nicotine Intake Estimates from Discarded Filter Butts to Examine Compensatory Smoking in Low Nicotine Cigarettes. Cancer Epidemiol Biomarkers Prev 2020; 29:643-649. [PMID: 32102909 PMCID: PMC7100998 DOI: 10.1158/1055-9965.epi-19-0905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/15/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A mandated reduction in the nicotine content of cigarettes could reduce smoking rate and prevalence. However, one concern is that smokers may compensate by increasing the intensity with which they smoke each cigarette to obtain more nicotine. This study assessed whether smokers engage in compensatory smoking by estimating the mouth-level nicotine intake of low nicotine cigarettes smoked during a clinical trial. METHODS Smokers were randomly assigned to receive cigarettes with one of five nicotine contents for 6 weeks. An additional group received a cigarette with the lowest nicotine content, but an increased tar yield. The obtained mouth-level nicotine intake from discarded cigarette butts for a subset of participants (51-70/group) was estimated using solanesol as described previously. A compensation index was calculated for each group to estimate the proportion of nicotine per cigarette recovered through changes in smoking intensity. RESULTS There was no significant increase in smoking intensity for any of the reduced nicotine cigarettes as measured by the compensation index (an estimated 0.4% of the nicotine lost was recovered in the lowest nicotine group; 95% confidence interval, -0.1 to 1.2). There was a significant decrease in smoking intensity for very low nicotine content cigarettes with increased tar yield. CONCLUSIONS Reductions in nicotine content did not result in compensatory changes in how intensively participants smoked research cigarettes. IMPACT Combined with data from clinical trials showing a reduction in cigarettes smoked per day, these data suggest that a reduction in nicotine content is unlikely to result in increased smoke exposure.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Dorothy K Hatsukami
- Department of Psychiatry and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Katelyn M Tessier
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Sharon E Murphy
- Department of Biochemistry Molecular Biology and BioPhysics and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, and Abraham Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Liza Valentin
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roberto Bravo Cardenas
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clifford Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James L Pirkle
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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21
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Denlinger-Apte RL, Cassidy RN, Colby SM, Sokolovsky AW, Tidey JW. Effects of Cigarette Nicotine Content and Menthol Preference on Perceived Health Risks, Subjective Ratings, and Carbon Monoxide Exposure Among Adolescent Smokers. Nicotine Tob Res 2019; 21:S56-S62. [PMID: 31867646 PMCID: PMC6939772 DOI: 10.1093/ntr/ntz127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Minimal research exists on adolescent smokers' perceptions of very low-nicotine-content (VLNC) cigarettes. As approximately half of adolescent smokers prefer menthol cigarettes, it is important to consider the influence of menthol preference on VLNC cigarette perceptions and to what extent menthol preference may affect VLNC smoking behavior. This study examined the effects of cigarette nicotine content and menthol preference or menthol smoking on health risk perceptions, subjective ratings, and carbon monoxide (CO) boost in adolescent smokers. METHODS Across two counterbalanced sessions, adolescent smokers sampled VLNC and normal nicotine content (NNC) research cigarettes following overnight abstinence. Cigarettes were mentholated or non-mentholated consistent with participants' usual brand. In each session, participants smoked the research cigarette and then completed the Perceived Health Risk Scale and Cigarette Evaluation Scale. Breath CO readings were obtained pre- and post-smoking. Mixed-factor ANOVA tests compared outcomes with cigarette type (VLNC vs. NNC) as the within-subjects factor and menthol preference as the between-subjects factor. RESULTS Participants (N = 50) were M = 17.7 years old, smoked M = 8.2 cigarettes/day, and 56% typically smoked menthol cigarettes. Participants reported lower risk of developing lung cancer, other cancers, emphysema, bronchitis, and heart disease (ps ≤ .05) when smoking VLNC cigarettes relative to NNC cigarettes. Perceived risk of addiction and stroke did not differ by nicotine content. Menthol preference or menthol smoking did not moderate risk perceptions, subjective ratings, or CO boost. CONCLUSIONS Adolescents may incorrectly perceive that VLNC cigarettes are less harmful products. Health communication campaigns could help to correct VLNC misperceptions and potentially minimize unintended consequences of a nicotine reduction policy.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
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Byron MJ, Hall MG, King JL, Ribisl KM, Brewer NT. Reducing Nicotine Without Misleading the Public: Descriptions of Cigarette Nicotine Level and Accuracy of Perceptions About Nicotine Content, Addictiveness, and Risk. Nicotine Tob Res 2019; 21:S101-S107. [PMID: 31867657 PMCID: PMC6939779 DOI: 10.1093/ntr/ntz161] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/05/2019] [Indexed: 01/14/2023]
Abstract
SIGNIFICANCE The public incorrectly believes very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes, a belief associated with lower motivation to quit under a VLNC standard. We examined how different descriptions of the nicotine level in VLNC cigarettes affect the accuracy of the public's perceptions about nicotine content, addictiveness, and cancer risk. METHODS Participants were a national convenience sample of 1353 US adults (22% smokers). In an online experiment, we randomized participants to a VLNC description using (1) concise language; (2) a percentage; (3) an interpretation; (4) a percentage and interpretation; (5) a percentage and a pictograph; or (6) a percentage, interpretation, and pictograph; or to a control description using (7) FDA's "minimally or nonaddictive" phrasing. We assessed accuracy of perceived nicotine content, addictiveness, and cancer risk compared to current cigarettes. RESULTS Compared to control, the percentage description resulted in more accurate perceptions about nicotine content (76% vs. 49% accuracy) and addictiveness (44% vs. 34%), but less accurate perceptions about cancer risk (56% vs. 68%; all ps < .05). Adding interpretation or pictographs to the percentage description did not increase accuracy. The concise language description reduced accuracy of perceived nicotine content and addictiveness but increased accuracy of cancer risk (all ps < .05). CONCLUSIONS Stating that 95% of nicotine would be removed more accurately conveyed the nicotine content and addictiveness of VLNC cigarettes. However, descriptions that better conveyed nicotine content and addictiveness misled people about cancer risk. IMPLICATIONS Implementation of a VLNC standard should include plans for a communication campaign that conveys that VLNC cigarettes will be less addictive but equally toxic to smoke. Stating the percent reduction in nicotine is likely to more clearly communicate reduced addictiveness but may also exacerbate risk misperceptions. VLNC communication requires further study to ensure the public accurately understands a VLNC standard.
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Affiliation(s)
- M Justin Byron
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jessica L King
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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23
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Denlinger-Apte RL, Kotlyar M, Koopmeiners JS, Tidey JW, Luo X, Benowitz NL, Jensen JA, Ikuemonisan JO, Pacek LR, Smith TT, Vandrey R, Donny EC, Hatsukami DK. Effects of Very Low Nicotine Content Cigarettes on Smoking Behavior and Biomarkers of Exposure in Menthol and Non-menthol Smokers. Nicotine Tob Res 2019; 21:S63-S72. [PMID: 31867637 PMCID: PMC6939781 DOI: 10.1093/ntr/ntz160] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/25/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Because 30% of cigarettes sold in the United States are characterized as menthol cigarettes, it is important to understand how menthol preference may affect the impact of a nicotine reduction policy. METHODS In a recent trial, non-treatment-seeking smokers were randomly assigned to receive very low nicotine cigarettes (VLNC; 0.4 mg nicotine/g tobacco) or normal nicotine cigarettes (NNC; 15.5 mg/g) for 20 weeks. On the basis of preference, participants received menthol or non-menthol cigarettes. We conducted multivariable regression analyses to examine whether menthol preference moderated the effects of nicotine content on cigarettes per day (CPD), breath carbon monoxide (CO), urinary total nicotine equivalents (TNE), urinary 2-cyanoethylmercapturic acid (CEMA), and abstinence. RESULTS At baseline, menthol smokers (n = 346) reported smoking fewer CPD (14.9 vs. 19.2) and had lower TNE (52.8 vs. 71.6 nmol/mg) and CO (17.7 vs. 20.5 ppm) levels than non-menthol smokers (n = 406; ps < .05). At week 20, significant interactions indicated that menthol smokers had smaller treatment effects than non-menthol smokers for CPD (-6.4 vs. -9.3), TNE (ratio of geometric means, 0.22 vs. 0.10) and CEMA (ratio, 0.56 vs. 0.37; ps < .05), and trended toward a smaller treatment effect for CO (-4.5 vs. -7.3 ppm; p = .06). Odds ratios for abstinence at week 20 were 1.88 (95% confidence interval [CI] = 0.8 to 4.4) for menthol and 9.11 (95% CI = 3.3 to 25.2) for non-menthol VLNC smokers (p = .02) relative to the NNC condition. CONCLUSIONS Although menthol smokers experienced reductions in smoking, toxicant exposure, and increases in quitting when using VLNC cigarettes, the magnitude of change was smaller than that observed for non-menthol smokers. IMPLICATIONS Results of this analysis suggest that smokers of menthol cigarettes may respond to a nicotine reduction policy with smaller reductions in smoking rates and toxicant exposure than would smokers of non-menthol cigarettes.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN
| | - Joseph S Koopmeiners
- Masonic Cancer Center and Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jennifer W Tidey
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Xianghua Luo
- Masonic Cancer Center and Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Joni A Jensen
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Joshua O Ikuemonisan
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Eric C Donny
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
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Imtiaz MH, Ramos-Garcia RI, Wattal S, Tiffany S, Sazonov E. Wearable Sensors for Monitoring of Cigarette Smoking in Free-Living: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4678. [PMID: 31661856 PMCID: PMC6864810 DOI: 10.3390/s19214678] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/28/2023]
Abstract
Globally, cigarette smoking is widespread among all ages, and smokers struggle to quit. The design of effective cessation interventions requires an accurate and objective assessment of smoking frequency and smoke exposure metrics. Recently, wearable devices have emerged as a means of assessing cigarette use. However, wearable technologies have inherent limitations, and their sensor responses are often influenced by wearers' behavior, motion and environmental factors. This paper presents a systematic review of current and forthcoming wearable technologies, with a focus on sensing elements, body placement, detection accuracy, underlying algorithms and applications. Full-texts of 86 scientific articles were reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines to address three research questions oriented to cigarette smoking, in order to: (1) Investigate the behavioral and physiological manifestations of cigarette smoking targeted by wearable sensors for smoking detection; (2) explore sensor modalities employed for detecting these manifestations; (3) evaluate underlying signal processing and pattern recognition methodologies and key performance metrics. The review identified five specific smoking manifestations targeted by sensors. The results suggested that no system reached 100% accuracy in the detection or evaluation of smoking-related features. Also, the testing of these sensors was mostly limited to laboratory settings. For a realistic evaluation of accuracy metrics, wearable devices require thorough testing under free-living conditions.
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Affiliation(s)
- Masudul H Imtiaz
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Raul I Ramos-Garcia
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Shashank Wattal
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Stephen Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 12246, USA.
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
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25
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Randomized Trial of Low-Nicotine Cigarettes and Transdermal Nicotine. Am J Prev Med 2019; 57:515-524. [PMID: 31542129 PMCID: PMC6756174 DOI: 10.1016/j.amepre.2019.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION A mandated reduction in the nicotine content of cigarettes may decrease smoking, but also increase demand for other nicotine products. The present study tested the impact of smoking cigarettes with very low nicotine content and concurrent use of a transdermal nicotine patch. STUDY DESIGN A balanced 2 × 2 factorial randomized clinical trial investigating the impact of cigarette nicotine content (double-blind, very low nicotine content versus normal nicotine content) and use of a transdermal nicotine patch (open label, patch versus no patch). SETTING/PARTICIPANTS Adult daily smokers (n=240) in the Pittsburgh, PA area. INTERVENTION Participants were provided with research cigarettes and transdermal nicotine patches (if assigned to patch condition) for 7 weeks. Cigarettes were Spectrum brand (National Institute on Drug Abuse) and either 15.8 mg nicotine/g tobacco (normal nicotine content) or 0.4 mg nicotine/g tobacco (very low nicotine content). In the 7th week, participants were monetarily incentivized to abstain from smoking. MAIN OUTCOME MEASURES Participants reported daily cigarette use throughout the trial and the primary outcome was average number of cigarettes smoked per day (study + nonstudy) during Week 6. Participants were recruited from 2015 to 2017 and data were analyzed between 2017 and 2018. RESULTS Assignment to very low nicotine content cigarettes and assignment to wear a nicotine patch both reduced the number of cigarettes smoked per day during Week 6 (p=0.001 and 0.04, respectively). However, assignment to the patch along with very low nicotine content cigarettes did not significantly reduce cigarette smoking compared with assignment to very low nicotine content cigarettes alone. CONCLUSIONS A mandated reduction in the nicotine content of cigarettes is likely to reduce the number of cigarettes smoked per day, but the added benefit of concurrent transdermal nicotine is unclear. Future studies should investigate whether alternative sources of noncombusted tobacco, such as e-cigarettes, enhance the effects of very low nicotine content cigarettes on smoking. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02301325.
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26
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Tucker MR, Laugesen M, Grace RC. Estimating Demand and Cross-Price Elasticity for Very Low Nicotine Content (VLNC) Cigarettes Using a Simulated Demand Task. Nicotine Tob Res 2019; 20:843-850. [PMID: 28340034 DOI: 10.1093/ntr/ntx051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 03/01/2017] [Indexed: 11/13/2022]
Abstract
Introduction Very Low Nicotine Content (VLNC) cigarettes might be useful as part of a tobacco control strategy, but relatively little is known about their acceptability as substitutes for regular cigarettes. We compared subjective effects and demand for regular cigarettes and VLNC cigarettes, and estimated cross-price elasticity for VLNC cigarettes, using simulated demand tasks. Method Forty New Zealand smokers sampled a VLNC cigarette and completed Cigarette Purchase Tasks to indicate their demand for regular cigarettes and VLNC cigarettes at a range of prices, and a cross-price task indicating how many regular cigarettes and VLNC cigarettes they would purchase at 0.5x, 1x, and 2x the current market price for regular cigarettes, assuming the price of VLNC cigarettes remained constant. They also rated the subjective effects of the VLNC cigarette and their usual-brand regular cigarettes. Results Cross-price elasticity for VLNC cigarettes was estimated as 0.32 and was significantly positive, indicating that VLNC cigarettes are partially substitutable for regular cigarettes. VLNC cigarettes were rated as less satisfying and psychologically rewarding than regular cigarettes, but this was unrelated to demand or substitutability. Conclusion VLNC cigarettes are potentially substitutable for regular cigarettes. Their availability may reduce tobacco consumption, nicotine intake and addiction; making it easier for smokers to quit. Implications VLNC cigarettes share the behavioral and sensory components of smoking while delivering negligible levels of nicotine. Although smokers rated VLNCs as less satisfying than regular cigarettes, smokers said they would increase their consumption of VLNCs as the price of regular cigarettes increased, if VLNCs were available at a lower price. This suggests that VLNCs are partially substitutable for regular cigarettes. VLNCs can be part of an effective tobacco control strategy, by reducing nicotine dependence and improving health and financial outcomes for smokers.
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Affiliation(s)
- Megan R Tucker
- University of Canterbury, Department of Psychology, Christchurch, New Zealand
| | - Murray Laugesen
- University of Canterbury, Department of Psychology, Christchurch, New Zealand.,Health New Zealand Ltd., Christchurch, New Zealand
| | - Randolph C Grace
- University of Canterbury, Department of Psychology, Christchurch, New Zealand
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27
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Kaizer AM, Koopmeiners JS, Hobbs BP. Bayesian hierarchical modeling based on multisource exchangeability. Biostatistics 2019; 19:169-184. [PMID: 29036300 DOI: 10.1093/biostatistics/kxx031] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/07/2017] [Indexed: 12/19/2022] Open
Abstract
Bayesian hierarchical models produce shrinkage estimators that can be used as the basis for integrating supplementary data into the analysis of a primary data source. Established approaches should be considered limited, however, because posterior estimation either requires prespecification of a shrinkage weight for each source or relies on the data to inform a single parameter, which determines the extent of influence or shrinkage from all sources, risking considerable bias or minimal borrowing. We introduce multisource exchangeability models (MEMs), a general Bayesian approach for integrating multiple, potentially non-exchangeable, supplemental data sources into the analysis of a primary data source. Our proposed modeling framework yields source-specific smoothing parameters that can be estimated in the presence of the data to facilitate a dynamic multi-resolution smoothed estimator that is asymptotically consistent while reducing the dimensionality of the prior space. When compared with competing Bayesian hierarchical modeling strategies, we demonstrate that MEMs achieve approximately 2.2 times larger median effective supplemental sample size when the supplemental data sources are exchangeable as well as a 56% reduction in bias when there is heterogeneity among the supplemental sources. We illustrate the application of MEMs using a recently completed randomized trial of very low nicotine content cigarettes, which resulted in a 30% improvement in efficiency compared with the standard analysis.
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Affiliation(s)
- Alexander M Kaizer
- Division of Biostatistics, University of Minnesota, A460 Mayo Building, MMC 303 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Joseph S Koopmeiners
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, USA
| | - Brian P Hobbs
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, USA
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28
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The Potential Impact of a Low Nicotine Product Standard for Cigarettes in Smokers Living With HIV. J Assoc Nurses AIDS Care 2019; 30:137-141. [PMID: 30822286 PMCID: PMC7014914 DOI: 10.1097/jnc.0000000000000027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Smith TT, Hatsukami DK, Benowitz NL, Colby SM, McClernon FJ, Strasser AA, Tidey JW, White CM, Donny EC. Whether to push or pull? Nicotine reduction and non-combusted alternatives - Two strategies for reducing smoking and improving public health. Prev Med 2018; 117:8-14. [PMID: 29604326 PMCID: PMC6163095 DOI: 10.1016/j.ypmed.2018.03.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/23/2018] [Accepted: 03/28/2018] [Indexed: 11/19/2022]
Abstract
Combustible cigarettes remain the most harmful and addictive tobacco product, and reducing the prevalence of smoking continues to be a critical public health goal. While nicotine is the constituent primarily responsible for addiction to cigarettes, most of the harm associated with smoking comes from byproducts of tobacco combustion. Recently, two different approaches for reducing the harms of smoking have emerged, both of which focus on breaking the link between the addiction to nicotine and the harms caused by smoking. First, the addictive potential of cigarettes could be minimized by requiring a large reduction in the nicotine content of cigarettes. Evidence for a nicotine reduction policy thus far shows that the use of very low nicotine content cigarettes results in a reduction in the number of cigarettes people smoke per day and a reduction in cigarette dependence. Second, emerging alternative nicotine delivery systems (ANDS) like electronic cigarettes may provide sufficient nicotine to act as substitutes for cigarettes while delivering much lower levels of toxicants. Evidence suggests that the emergence of ANDS has increased the percentage of smokers who are able to quit. The present paper will briefly review the evidence for each of these approaches, and consider what contemporary reinforcement and addiction theories can tell us about their likely success. We argue that the most effective endgame approach is one that pursues both nicotine reduction and alternative nicotine delivery systems as complementary.
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Affiliation(s)
- Tracy T Smith
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States.
| | | | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California San Francisco, United States
| | - Suzanne M Colby
- Center for Alcohol & Addiction Studies, Brown University, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, United States
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, United States
| | - Jennifer W Tidey
- Center for Alcohol & Addiction Studies, Brown University, United States
| | - Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, United States
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, United States
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30
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Higgins ST, Bergeria CL, Davis DR, Streck JM, Villanti AC, Hughes JR, Sigmon SC, Tidey JW, Heil SH, Gaalema DE, Stitzer ML, Priest JS, Skelly JM, Reed DD, Bunn JY, Tromblee MA, Arger CA, Miller ME. Response to reduced nicotine content cigarettes among smokers differing in tobacco dependence severity. Prev Med 2018; 117:15-23. [PMID: 29626557 PMCID: PMC6748869 DOI: 10.1016/j.ypmed.2018.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022]
Abstract
This study examines whether tobacco dependence severity moderates the acute effects of reducing nicotine content in cigarettes on the addiction potential of smoking, craving/withdrawal, or smoking topography. Participants (N = 169) were daily smokers with mild, moderate, or high tobacco-dependence severity using the Heaviness of Smoking Index. Following brief abstinence, participants smoked research cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg nicotine/g tobacco) in a within-subject design. Results were analyzed using repeated measures analysis of co-variance. No main effects of dependence severity or interactions with nicotine dose were noted in relative reinforcing effects in concurrent choice testing or subjective effects on the modified Cigarette Evaluation Questionnaire. Demand for smoking in the Cigarette Purchase Task was greater among more dependent smokers, but reducing nicotine content decreased demand independent of dependence severity. Dependence severity did not significantly alter response to reduced nicotine content cigarettes on the Minnesota Tobacco Withdrawal Scale nor Questionnaire of Smoking Urges-brief (QSU) Factor-2 scale; dependence severity and dose interacted significantly on the QSU-brief Factor-1 scale, with reductions dependent on dose among highly but not mildly or moderately dependent smokers. Dependence severity and dose interacted significantly on only one of six measures of smoking topography (i.e., maximum flow rate), which increased as dose increased among mildly and moderately but not highly dependent smokers. These results suggest that dependence severity has no moderating influence on the ability of reduced nicotine content cigarettes to lower the addiction potential of smoking, and minimal effects on relief from craving/withdrawal or smoking topography.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States.
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Andrea C Villanti
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Joan M Skelly
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, United States
| | - Janice Y Bunn
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Morgan A Tromblee
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Christopher A Arger
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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31
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Hatsukami DK, Luo X, Jensen JA, al'Absi M, Allen SS, Carmella SG, Chen M, Cinciripini PM, Denlinger-Apte R, Drobes DJ, Koopmeiners JS, Lane T, Le CT, Leischow S, Luo K, McClernon FJ, Murphy SE, Paiano V, Robinson JD, Severson H, Sipe C, Strasser AA, Strayer LG, Tang MK, Vandrey R, Hecht SS, Benowitz NL, Donny EC. Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke Exposure: A Randomized Clinical Trial. JAMA 2018; 320:880-891. [PMID: 30193275 PMCID: PMC6372240 DOI: 10.1001/jama.2018.11473] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance The optimal temporal approach for reducing nicotine to minimally or nonaddictive levels in all cigarettes sold in the United States has not been determined. Objectives To determine the effects of immediate vs gradual reduction in nicotine content to very low levels and as compared with usual nicotine level cigarettes on biomarkers of toxicant exposure. Design, Setting, and Participants A double-blind, randomized, parallel-design study with 2 weeks of baseline smoking and 20 weeks of intervention was conducted at 10 US sites. A volunteer sample of daily smokers with no intention to quit within 30 days was recruited between July 2014 and September 2016, with the last follow-up completed in March 2017. Interventions (1) Immediate reduction to 0.4 mg of nicotine per gram of tobacco cigarettes; (2) gradual reduction from 15.5 mg to 0.4 mg of nicotine per gram of tobacco cigarettes with 5 monthly dose changes; or (3) maintenance on 15.5 mg of nicotine per gram of tobacco cigarettes. Main Outcomes and Measures Between-group differences in 3 co-primary biomarkers of smoke toxicant exposure: breath carbon monoxide (CO), urine 3-hydroxypropylmercapturic acid (3-HPMA, metabolite of acrolein), and urine phenanthrene tetraol (PheT, indicator of polycyclic aromatic hydrocarbons) calculated as area under the concentration-time curve over the 20 weeks of intervention. Results Among 1250 randomized participants (mean age, 45 years; 549 women [44%]; 958 [77%] completed the trial), significantly lower levels of exposure were observed in the immediate vs gradual reduction group for CO (mean difference, -4.06 parts per million [ppm] [95% CI, -4.89 to -3.23]; P < .0055), 3-HPMA (ratio of geometric means, 0.83 [95% CI, 0.77 to 0.88]; P < .0055), and PheT (ratio of geometric means, 0.88 [95% CI, 0.83 to 0.93]; P < .0055). Significantly lower levels of exposure were observed in the immediate reduction vs control group for CO (mean difference, -3.38 [95% CI, -4.40 to -2.36]; P < .0055), 3-HPMA (ratio of geometric means, 0.81 [95% CI, 0.75 to 0.88]; P < .0055), and PheT (ratio of geometric means, 0.86 [95% CI, 0.81 to 0.92]; P < .0055). No significant differences were observed between the gradual reduction vs control groups for CO (mean difference, 0.68 [95% CI, -0.31 to 1.67]; P = .18), 3-HPMA (ratio of geometric means, 0.98 [95% CI, 0.91 to 1.06]; P = .64), and PheT (ratio of geometric means, 0.98 [95% CI, 0.92 to 1.04]; P = .52). Conclusions and Relevance Among smokers, immediate reduction of nicotine in cigarettes led to significantly greater decreases in biomarkers of smoke exposure across time compared with gradual reduction or a control group, with no significant differences between gradual reduction and control. Trial Registration clinicaltrials.gov Identifier: NCT02139930.
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Affiliation(s)
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Joni A Jensen
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Mustafa al'Absi
- Behavioral Medicine Laboratories, University of Minnesota Medical School, Duluth
| | - Sharon S Allen
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis
| | | | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Rachel Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
| | - David J Drobes
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | | | - Tonya Lane
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Chap T Le
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Scott Leischow
- Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Kai Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | | | - Viviana Paiano
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Jason D Robinson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Lori G Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Mei Kuen Tang
- Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Dermody SS, McClernon FJ, Benowitz N, Luo X, Tidey JW, Smith TT, Vandrey R, Hatsukami D, Donny EC. Effects of reduced nicotine content cigarettes on individual withdrawal symptoms over time and during abstinence. Exp Clin Psychopharmacol 2018; 26:223-232. [PMID: 29504780 PMCID: PMC5986583 DOI: 10.1037/pha0000179] [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] [Indexed: 12/30/2022]
Abstract
In the United States, the Food and Drug Administration (FDA) has initiated a public dialogue about reducing the nicotine content of cigarettes. A reduced-nicotine standard could increase withdrawal symptoms among current smokers. We examined the impact of switching smokers to cigarettes that varied in nicotine content on withdrawal symptoms over 6 weeks. A secondary analysis (N = 839) of a 10-site, double-blind clinical trial of nontreatment-seeking smokers was completed. Participants were instructed to smoke study cigarettes, containing 0.4 to 15.8 mg of nicotine/g of tobacco, for 6 weeks and were then abstinent overnight. Using latent growth curves, trajectories of individual withdrawal symptoms were compared between the reduced nicotine content (RNC) conditions and a normal nicotine content (NNC) condition. Path analyses compared symptoms after overnight abstinence. Relative to NNC cigarettes, participants smoking RNC cigarettes had increased anger/irritability/frustration and increased appetite/weight gain during the initial weeks, but the symptoms resolved by Week 6. Individuals who were biochemically verified as adherent with using only the 0.4 mg/g cigarettes had higher sadness levels (Cohen's d = .40) at Week 6 compared with the NNC condition, although symptoms were mild. After a post-Week 6 overnight abstinence challenge, some RNC conditions relative to NNC condition exhibited reduced withdrawal. Individuals who were biochemically confirmed as adherent to the lowest nicotine condition experienced only mild and transient symptom elevations. Thus, a reduced-nicotine standard for cigarettes produced a relatively mild and temporary increase in withdrawal among nontreatment-seeking smokers (ClinicalTrials.gov No. NCT01681875). (PsycINFO Database Record
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Affiliation(s)
- Sarah S. Dermody
- Centre for Addiction and Mental Health, Toronto Ontario Canada,School of Psychological Science, Oregon State University,Corresponding author: Sarah Dermody, PhD, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR 97331, 541-737-1358,
| | - F. Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, School of Medicine
| | - Neal Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco
| | - Xianghua Luo
- Division of Biostatistics, Department of Public Health, University of Minnesota, MN USA,Masonic Cancer Center, University of Minnesota, MN USA
| | - Jennifer W. Tidey
- Centre for Alcohol and Addiction Studies, Brown University, Providence RI
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Dorothy Hatsukami
- Masonic Cancer Center, University of Minnesota, MN USA,Departments of Psychiatry, University of Minnesota, MN USA
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Higgins ST, Redner R, Priest JS, Bunn JY. Socioeconomic Disadvantage and Other Risk Factors for Using Higher-Nicotine/Tar-Yield (Regular Full-Flavor) Cigarettes. Nicotine Tob Res 2018; 19:1425-1433. [PMID: 27613929 DOI: 10.1093/ntr/ntw201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/23/2016] [Indexed: 12/27/2022]
Abstract
Introduction Use of machine-estimated higher nicotine/tar yield (regular full-flavor) cigarettes is associated with increased risk of nicotine dependence. The present study examined risk factors for using full-flavor versus other cigarette types, including socioeconomic disadvantage and other risk factors for tobacco use or tobacco-related adverse health impacts. Associations between use of full-flavor cigarettes and risk of nicotine dependence were also examined. Methods Data were obtained from nationally representative samples of adult cigarette smokers from the US National Survey on Drug Use and Health. Logistic regression and classification and regression tree modeling were used to examine associations between use of full-flavor cigarettes and educational attainment, poverty, race/ethnicity, age, sex, mental illness, alcohol abuse/dependence, and illicit drug abuse/dependence. Logistic regression was used to examine risk for nicotine dependence. Results Each of these risk factors except alcohol abuse/dependence independently predicted increased odds of using full-flavor cigarettes (p < .001), with lower educational attainment the strongest predictor, followed by poverty, male sex, younger age, minority race/ethnicity, mental illness, and drug abuse/dependence, respectively. Use of full-flavor cigarettes was associated with increased odds of nicotine dependence within each of these risk factor groupings (p < .01). Cart modeling identified how prevalence of full-flavor cigarette use can vary from a low of 25% to a high of 66% corresponding to differing combinations of these independent risk factors. Conclusions Use of full-flavor cigarettes is overrepresented in socioeconomically disadvantaged and other vulnerable populations, and associated with increased risk of nicotine dependence. Greater regulation of this cigarette type may be warranted. Implications Greater regulation of commercially available Regular Full-Flavor Cigarettes may be warranted. Use of this type of cigarette is overrepresented in socioeconomically disadvantaged and other vulnerable populations and associated with increased risk for nicotine dependence.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Ryan Redner
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Rehabilitation Institute, Southern Illinois University, Carbondale, IL
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Department of Medical Biostatistics, University of Vermont, Burlington, VT
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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: 15] [Impact Index Per Article: 2.5] [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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Xue S, Kallupi M, Zhou B, Smith LC, Miranda PO, George O, Janda KD. An enzymatic advance in nicotine cessation therapy. Chem Commun (Camb) 2018; 54:1686-1689. [PMID: 29308799 PMCID: PMC6231713 DOI: 10.1039/c7cc09134f] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A nicotine-degrading enzyme termed NicA2 was altered (NicA2-J1) through fusion of an albumin binding domain to increase its half-life. Examination of NicA2-J1 in vivo demonstrated a complete blockade of brain nicotine access, which in turn blunted nicotine's psychoactive effects. These data further support development of pharmacokinetic nicotine cessation therapeutics.
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Affiliation(s)
- Song Xue
- Departments of Chemistry, Immunology, Microbiology and The Skaggs Institute for Chemical Biology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California 92037, USA.
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Byron MJ, Jeong M, Abrams DB, Brewer NT. Public misperception that very low nicotine cigarettes are less carcinogenic. Tob Control 2018; 27:712-714. [PMID: 29363610 DOI: 10.1136/tobaccocontrol-2017-054124] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The USA is considering a very low nicotine content (VLNC) cigarette standard. We sought to characterise the prevalence and correlates of the incorrect belief that VLNC cigarettes are less carcinogenic than current cigarettes, as this could reduce motivation to quit. METHODS Participants were a nationally representative sample of 650 adult smokers in the USA. In 2015-2016, before the VLNC proposal became public, these smokers took part in an online survey. We used multivariate weighted analyses to calculate ORs and percentages and a χ2 test to examine the association between variables. RESULTS Overall, 47.1% of smokers believed that smoking VLNC cigarettes for 30 years would be less likely to cause cancer than smoking current cigarettes. This misperception was more common among smokers who were aged above 55 (56.6%) and black (57.4%). Additionally, 23.9% of smokers reported they would be less likely to quit if the USA adopted a VLNC standard. Thinking that VLNC cigarettes would be less carcinogenic was associated with smokers reporting they would be less likely to quit (P<0.01). CONCLUSIONS Many smokers had the misperception that smoking VLNC cigarettes is less likely to cause cancer, and some stated that they would be less likely to quit. A VLNC standard may be more effective if accompanied by a communication campaign that emphasises the continued dangers of smoking VLNC cigarettes due to the many toxic chemicals in smoke.
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Affiliation(s)
- M Justin Byron
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michelle Jeong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David B Abrams
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City, New York, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Abstract
The present systematic review examines whether very low nicotine content (VLNC) cigarettes ameliorate withdrawal-induced impairments in behavioral/cognitive performance. PubMed, PsycInfo, and Web of Science were searched for performance effects of VLNC cigarettes. For inclusion, reports had to be in English, published in a peer-reviewed journal through June 2017, examine VLNC cigarettes (<0.2mg nicotine yield), include ≥2hour smoking abstinence or reduced nicotine exposure, and examine performance. 19 of 1243 articles reviewed met inclusion criteria. Poorer performance after smoking VLNC versus normal nicotine content (NNC) cigarettes was observed across 7 of 10 domains, including reaction time (8/11), short-term memory (3/10), sustained attention (4/6), inhibitory control (1/4), long-term memory (3/3 studies), and response variability (2/2). In two studies, combining VLNC smoking with nicotine replacement therapy (NRT) resulted in performance that was comparable to performance after NNC smoking. VLNC versus NNC differences were not discerned in motor control/functioning (0/2), visuospatial processing (0/2), learning (0/1), or verbal fluency (0/1). Eleven of nineteen (58%) studies were rated of Good or Excellent quality. Overall, VLNC cigarettes may not fully ameliorate withdrawal-induced disruptions in performance, although this varies by domain, with the strongest evidence for reaction time. Importantly, combining VLNC cigarettes with NRT appears to ameliorate withdrawal that is not reduced by VLNC cigarettes alone. As only 19 studies were identified, many domains are under-investigated. A more thorough evaluation of the extent to which VLNC cigarettes affect withdrawal-impaired performance may be warranted.
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Higgins ST, Heil SH, Sigmon SC, Tidey JW, Gaalema DE, Hughes JR, Stitzer ML, Durand H, Bunn JY, Priest JS, Arger CA, Miller ME, Bergeria CL, Davis DR, Streck JM, Reed DD, Skelly JM, Tursi L. Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction. JAMA Psychiatry 2017; 74:1056-1064. [PMID: 28832876 PMCID: PMC5710465 DOI: 10.1001/jamapsychiatry.2017.2355] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States. OBJECTIVE To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content. DESIGN, SETTING, AND PARTICIPANTS A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016. INTERVENTIONS After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions. MAIN OUTCOMES AND MEASURES Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale. RESULTS Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η2 = 0.008; dose-by-time interaction, P = .002). CONCLUSIONS AND RELEVANCE Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.
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Affiliation(s)
- Stephen T. Higgins
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Sarah H. Heil
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Stacey C. Sigmon
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Diann E. Gaalema
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - John R. Hughes
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Maxine L. Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hanna Durand
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Janice Y. Bunn
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Jeff S. Priest
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Christopher A. Arger
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Cecilia L. Bergeria
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Danielle R. Davis
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Joanna M. Streck
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Derek D. Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence
| | - Joan M. Skelly
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Lauren Tursi
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
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Faulkner P, Ghahremani DG, Tyndale RF, Cox CM, Kazanjian AS, Paterson N, Lotfipour S, Hellemann GS, Petersen N, Vigil C, London ED. Reduced-Nicotine Cigarettes in Young Smokers: Impact of Nicotine Metabolism on Nicotine Dose Effects. Neuropsychopharmacology 2017; 42:1610-1618. [PMID: 28117337 PMCID: PMC5518898 DOI: 10.1038/npp.2017.18] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/16/2016] [Accepted: 01/19/2017] [Indexed: 01/05/2023]
Abstract
The use of cigarettes delivering different nicotine doses allows evaluation of the contribution of nicotine to the smoking experience. We compared responses of 46 young adult smokers to research cigarettes, delivering 0.027, 0.110, 0.231, or 0.763 mg nicotine, and conventional cigarettes. On five separate days, craving, withdrawal, affect, and sustained attention were measured after overnight abstinence and again after smoking. Participants also rated each cigarette, and the nicotine metabolite ratio (NMR) was used to identify participants as normal or slow metabolizers. All cigarettes equally alleviated craving, withdrawal, and negative affect in the whole sample, but normal metabolizers reported greater reductions of craving and withdrawal than slow metabolizers, with dose-dependent effects. Only conventional cigarettes and, to a lesser degree, 0.763-mg nicotine research cigarettes increased sustained attention. Finally, there were no differences between ratings of lower-dose cigarettes, but the 0.763-mg cigarettes and (even more so) conventional cigarettes were rated more favorably than lower-dose cigarettes. The findings indicate that smoking-induced relief of craving and withdrawal reflects primarily non-nicotine effects in slow metabolizers, but depends on nicotine dose in normal metabolizers. By contrast, relief of withdrawal-related attentional deficits and cigarette ratings depend on nicotine dose regardless of metabolizer status. These findings have bearing on the use of reduced-nicotine cigarettes to facilitate smoking cessation and on policy regarding regulation of nicotine content in cigarettes. They suggest that normal and slow nicotine metabolizers would respond differently to nicotine reduction in cigarettes, but that irrespective of metabolizer status, reductions to <0.763 mg/cigarette may contribute to temporary attentional deficits.
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Affiliation(s)
- Paul Faulkner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health (CAMH), University of Toronto, 1 King’s College Circle, Toronto, ON, Canada,Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health (CAMH), University of Toronto, 1 King’s College Circle, Toronto, ON, Canada
| | - Chelsea M Cox
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Ari S Kazanjian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Neil Paterson
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Shahrdad Lotfipour
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Nicole Petersen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Celia Vigil
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90025, USA, Tel: 310 825 0606, Fax: 310 825-0812, E-mail:
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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: 36] [Impact Index Per Article: 5.1] [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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Higgins ST, Heil SH, Sigmon SC, Tidey JW, Gaalema DE, Stitzer ML, Durand H, Bunn JY, Priest JS, Arger CA, Miller ME, Bergeria CL, Davis DR, Streck JM, Zvorsky I, Redner R, Vandrey R, Pacek LR. Response to varying the nicotine content of cigarettes in vulnerable populations: an initial experimental examination of acute effects. Psychopharmacology (Berl) 2017; 234:89-98. [PMID: 27714427 PMCID: PMC5203959 DOI: 10.1007/s00213-016-4438-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/14/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE The purpose of this study was to begin researching the effects of very low nicotine content cigarettes in smokers especially vulnerable to dependence to assess their potential as a less dependence-producing alternative to current commercial cigarettes. METHODS Participants were 26 adult, daily cigarette smokers from one of three populations: economically disadvantaged women of reproductive age (n = 9), opioid-dependent individuals (n = 11), and individuals with affective disorders (n = 6). Participants completed fourteen 2-4-h experimental sessions in a within-subjects research design. Sessions were conducted following brief smoking abstinence. Four research cigarettes varying in nicotine content (0.4, 2.4, 5.2, and 15.8 mg/g) were studied under double-blind conditions, assessing smoking topography, subjective effects, and relative reinforcing effects of varying doses in concurrent choice tests. Results were collapsed across vulnerable populations and analyzed using repeated measures ANOVA. RESULTS No significant differences between doses were discernible in smoking topography. All doses were equi-effective at reducing nicotine withdrawal. Ratings of satisfaction from smoking were lower at the 0.4 compared to 15.8 mg/g dose. Participants preferred the 15.8 mg/g dose over the 0.4 and 2.4 but not the 5.2 mg/g doses in concurrent choice testing; no differences between the two lowest doses were noted. CONCLUSIONS All cigarettes effectively reduced nicotine withdrawal with no differences in smoking topography, suggesting minimal compensatory smoking. Dependence potential was lowest at the 0.4 mg/g dose. These initial results are promising regarding the feasibility of lowering nicotine content in cigarettes to very low levels in vulnerable populations without untoward effects.
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Affiliation(s)
| | - Sarah H. Heil
- University of Vermont Center on Tobacco Regulatory Science
| | | | | | | | | | - Hanna Durand
- University of Vermont Center on Tobacco Regulatory Science
| | - Janice Y. Bunn
- University of Vermont Center on Tobacco Regulatory Science
| | - Jeff S. Priest
- University of Vermont Center on Tobacco Regulatory Science
| | | | | | | | | | | | - Ivori Zvorsky
- University of Vermont Center on Tobacco Regulatory Science
| | - Ryan Redner
- University of Vermont Center on Tobacco Regulatory Science,Southern Illinois University
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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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Henningfield JE, Smith TT, Kleykamp BA, Fant RV, Donny EC. Nicotine self-administration research: the legacy of Steven R. Goldberg and implications for regulation, health policy, and research. Psychopharmacology (Berl) 2016; 233:3829-3848. [PMID: 27766371 PMCID: PMC5588156 DOI: 10.1007/s00213-016-4441-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND RATIONALE Steven R. Goldberg was a pioneering behavioral pharmacologist whose intravenous drug self-administration studies advanced the understanding of conditioned stimuli and schedules of reinforcement as determinants of pattern and persistence of drug-seeking behavior, and in particular, the importance of nicotine in tobacco use. His passing in 2014 led to invitations to contribute articles to psychopharmacology dedicated to his work. OBJECTIVES The objectives of this review are to summarize and put into historical perspective Goldberg's contributions to elucidate the reinforcing effects of nicotine and to summarize the implications of his research for medication development, tobacco regulation, and potential tobacco control policy options. This includes a review of intravenous nicotine self-administration research from the 1960s to 2016. RESULTS Goldberg's application of behavioral pharmacology methods to investigate nicotine reinforcement and the influence of schedule of reinforcement and conditioned stimuli on nicotine administration contributed to the conclusions of the US National Institute on Drug Abuse, and the Surgeon General, that nicotine met the criteria as a dependence-producing drug and cigarette smoking as a prototypic drug dependency or "addiction." Equally important, this work has been systematically extended to other species and applied to address a range of factors relevant to tobacco use, medication development, regulation, and public health policy. CONCLUSIONS Steven R. Goldberg was a pioneering scientist whose systematic application of the science of behavioral pharmacology advanced the understanding of tobacco and nicotine use and contributed to the scientific foundation for tobacco product regulation and potential public health tobacco control policy development.
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Affiliation(s)
- Jack E Henningfield
- Pinney Associates, 4800 Montgomery Lane, Suite 400, Bethesda, MD, 20814, USA.
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Tracy T Smith
- University of Pittsburgh Cancer Institute, 4120 Sennott Square, 210 S. Bouquet Street, Pittsburgh, PA, 15260, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4120 Sennott Square, 210 S. Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Bethea A Kleykamp
- Pinney Associates, 4800 Montgomery Lane, Suite 400, Bethesda, MD, 20814, USA
| | - Reginald V Fant
- Pinney Associates, 4800 Montgomery Lane, Suite 400, Bethesda, MD, 20814, USA
| | - Eric C Donny
- Department of Psychology, University of Pittsburgh, 210 S. Bouquet Street, Pittsburgh, PA, 15260, USA
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Donny EC, Walker N, Hatsukami D, Bullen C. Reducing the nicotine content of combusted tobacco products sold in New Zealand. Tob Control 2016; 26:e37-e42. [DOI: 10.1136/tobaccocontrol-2016-053186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 11/04/2022]
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Dermody SS, Tidey JW, Denlinger RL, Pacek LR, al'Absi M, Drobes DJ, Hatsukami DK, Vandrey R, Donny EC. The Impact of Smoking Very Low Nicotine Content Cigarettes on Alcohol Use. Alcohol Clin Exp Res 2016; 40:606-15. [PMID: 26916879 DOI: 10.1111/acer.12980] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/04/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Reducing the nicotine content in cigarettes could improve public health by reducing smoking and toxicant exposure, but may also have unintended consequences on alcohol use. The primary objective of this study was to examine the effect of reducing the nicotine content in cigarettes on alcohol outcomes. The secondary aim was to examine whether the effects of these cigarettes on alcohol outcomes were mediated by changes in nicotine exposure, smoking behavior, or withdrawal. METHODS Between June 2013 and July 2014, we conducted a 7-arm, double-blind, randomized clinical trial at 10 U.S.-based sites. Daily smokers not currently interested in quitting (n = 839) were assigned to equally sized groups to smoke for 6 weeks cigarettes containing either normal nicotine content (NNC; 15.8 mg/g, 9 mg tar), moderate nicotine content (5.2 mg/g nicotine, 9 mg tar), or very low nicotine content (VLNC; 0.4 to 2.4 mg/g, 9 to 13 mg tar). This investigation focused on a subsample of current drinkers (n = 403). Each reduced nicotine content cigarette condition was compared to the NNC control condition with respect to trajectories over the 6-week period of average daily alcohol use and occurrence of binge drinking. Moderating variables were considered. Mediation analyses tested potential explanatory processes including changes in nicotine exposure, cigarettes per day, and withdrawal. RESULTS Over time, reduced nicotine exposure and smoking rate mediated effects of VLNC cigarette use on reduced alcohol use. There was no evidence of compensatory drinking in response to nicotine reduction or nicotine withdrawal, even among subgroups expected to be at greater risk (e.g., relatively heavier drinkers, highly nicotine-dependent individuals). CONCLUSIONS The findings suggest that compensatory drinking is unlikely to occur in response to switching to VLNC cigarettes. In contrast, reducing the nicotine content of cigarettes may reduce alcohol use (clinicalTrials.gov number, NCT01681875).
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology , University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies , Brown University, Providence, Rhode Island
| | - Rachel L Denlinger
- Center for Alcohol and Addiction Studies , Brown University, Providence, Rhode Island
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences , Duke University Medical Center, Durham, North Carolina
| | | | - David J Drobes
- Department of Health Outcomes and Behavior , Moffitt Cancer Center, Tampa, Florida
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry , University of Minnesota, Minneapolis, Minnesota
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric C Donny
- Department of Psychology , University of Pittsburgh, Pittsburgh, Pennsylvania
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Redner R, White TJ, Bunn JY, Higgins ST. Use of High-Nicotine/Tar-Yield (Full-Flavor) Cigarettes and Risk for Nicotine Dependence in Nationally Representative Samples of US Smokers. Nicotine Tob Res 2015; 18:1424-30. [PMID: 26547061 DOI: 10.1093/ntr/ntv252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/27/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The present study examines whether use of machine-estimated high-nicotine/tar-yield (full-flavor) cigarettes predicts greater risk of nicotine dependence after controlling for the influence of potential confounding factors in US nationally representative samples. METHODS Data were obtained from multiple years of the National Survey on Drug Use and Health (NSDUH). Nicotine dependence was measured by (1) the Nicotine Dependence Syndrome Scale and (2) latency to first cigarette after waking. Associations between use of high-nicotine/tar-yield cigarettes and risk for nicotine dependence were examined using multiple logistic regression. RESULTS The odds of nicotine dependence were reliably greater among users of high- compared to lower-nicotine/tar-yield cigarettes even after adjusting for sociodemographic and other smoking characteristics (Ps < .0001). This relationship was (1) generally graded across differing nicotine/tar-yield cigarettes, (2) discernible across two definitions of nicotine dependence and multiple NSDUH survey years, and (3) observed among adult and adolescent smokers. CONCLUSION Use of high-nicotine/tar-yield cigarettes is associated with increased odds of nicotine dependence, a relationship that has important tobacco regulatory implications. Whether the widespread marketing and availability of high-nicotine/tar-yield cigarettes is increasing risk of nicotine dependence among US smokers warrants further research. IMPLICATIONS This study adds additional empirical evidence to the relation of machine measured high-yield cigarettes and likelihood of nicotine dependence, and draws some implications in regards to regulation.
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Affiliation(s)
- Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Behavior Analysis and Therapy Program, Rehabilitation Institute, Southern Illinois University, Carbondale, Carbondale, IL
| | - Thomas J White
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychology, University of Vermont, Burlington, VT
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Benowitz NL, Nardone N, Dains KM, Hall SM, Stewart S, Dempsey D, Jacob P. Effect of reducing the nicotine content of cigarettes on cigarette smoking behavior and tobacco smoke toxicant exposure: 2-year follow up. Addiction 2015; 110:1667-75. [PMID: 26198394 PMCID: PMC4565734 DOI: 10.1111/add.12978] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/09/2015] [Accepted: 04/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS A broadly mandated reduction of the nicotine content (RNC) of cigarettes has been proposed in the United States to reduce the addictiveness of cigarettes, to prevent new smokers from becoming addicted and to facilitate quitting in established smokers. The primary aim of this study was to determine whether following 7 months of smoking very low nicotine content cigarettes (VLNC), and then returning to their own cigarettes, smokers would demonstrate persistently reduced nicotine intake compared with baseline or quit smoking. METHODS In a community-based clinic 135 smokers not interested in quitting were randomized to one of two groups. A research group smoked their usual brand of cigarettes, followed by five types of research cigarettes with progressively lower nicotine content, each for 1 month, followed by 6 months at the lowest nicotine level (0.5 mg/cigarette) (53 subjects) and then 12 months with no intervention (30 subjects completed). A control group smoked their usual brand for the same period of time (50 subjects at 6 months, 38 completed). Smoking behavior, biomarkers of nicotine intake and smoke toxicant exposure were measured. RESULTS After 7 months smoking VLNC, nicotine intake remained below baseline (plasma cotinine 149 versus 250 ng/ml, P<0.005) with no significant change in cigarettes per day or expired carbon monoxide (CO). During the 12-month follow-up, cotinine levels in RNC smokers rose to baseline levels and to those of control smokers. Quit rates among RNC smokers were very low [7.5 versus 2% in controls, not significant). CONCLUSIONS In smokers not interested in quitting, reducing the nicotine content in cigarettes over 12 months does not appear to result in extinction of nicotine dependence, assessed by persistently reduced nicotine intake or quitting smoking over the subsequent 12 months.
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Affiliation(s)
- Neal L. Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Natalie Nardone
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Katherine M. Dains
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Sharon M. Hall
- Department of Psychiatry, University of California, San Francisco
| | - Susan Stewart
- Department of Public Health Sciences, University of California Davis
| | - Delia Dempsey
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Peyton Jacob
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco
- Department of Psychiatry, University of California, San Francisco
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Donny EC, Denlinger RL, Tidey JW, Koopmeiners JS, Benowitz NL, Vandrey RG, al'Absi M, Carmella SG, Cinciripini PM, Dermody SS, Drobes DJ, Hecht SS, Jensen J, Lane T, Le CT, McClernon FJ, Montoya ID, Murphy SE, Robinson JD, Stitzer ML, Strasser AA, Tindle H, Hatsukami DK. Randomized Trial of Reduced-Nicotine Standards for Cigarettes. N Engl J Med 2015; 373:1340-9. [PMID: 26422724 PMCID: PMC4642683 DOI: 10.1056/nejmsa1502403] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Food and Drug Administration can set standards that reduce the nicotine content of cigarettes. METHODS We conducted a double-blind, parallel, randomized clinical trial between June 2013 and July 2014 at 10 sites. Eligibility criteria included an age of 18 years or older, smoking of five or more cigarettes per day, and no current interest in quitting smoking. Participants were randomly assigned to smoke for 6 weeks either their usual brand of cigarettes or one of six types of investigational cigarettes, provided free. The investigational cigarettes had nicotine content ranging from 15.8 mg per gram of tobacco (typical of commercial brands) to 0.4 mg per gram. The primary outcome was the number of cigarettes smoked per day during week 6. RESULTS A total of 840 participants underwent randomization, and 780 completed the 6-week study. During week 6, the average number of cigarettes smoked per day was lower for participants randomly assigned to cigarettes containing 2.4, 1.3, or 0.4 mg of nicotine per gram of tobacco (16.5, 16.3, and 14.9 cigarettes, respectively) than for participants randomly assigned to their usual brand or to cigarettes containing 15.8 mg per gram (22.2 and 21.3 cigarettes, respectively; P<0.001). Participants assigned to cigarettes with 5.2 mg per gram smoked an average of 20.8 cigarettes per day, which did not differ significantly from the average number among those who smoked control cigarettes. Cigarettes with lower nicotine content, as compared with control cigarettes, reduced exposure to and dependence on nicotine, as well as craving during abstinence from smoking, without significantly increasing the expired carbon monoxide level or total puff volume, suggesting minimal compensation. Adverse events were generally mild and similar among groups. CONCLUSIONS In this 6-week study, reduced-nicotine cigarettes versus standard-nicotine cigarettes reduced nicotine exposure and dependence and the number of cigarettes smoked. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration Center for Tobacco Products; ClinicalTrials.gov number, NCT01681875.).
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Affiliation(s)
- Eric C Donny
- From the Departments of Psychology (E.C.D., R.L.D., S.S.D., T.L.) and Medicine (H.T.), University of Pittsburgh, Pittsburgh; the Center for Alcohol and Addiction Studies, Brown University, Providence, RI (J.W.T.); the Division of Biostatistics, School of Public Health (J.S.K., C.T.L.), the Departments of Biochemistry, Molecular Biology, and Biophysics (S.E.M.) and Psychiatry (D.K.H.) and the Masonic Cancer Center (J.S.K., S.G.C., S.S.H., J.J., C.T.L., S.E.M., D.K.H.), University of Minnesota, Minneapolis, and the University of Minnesota Medical School, Duluth (M.A.) - all in Minnesota; the Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco (N.L.B.); the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (R.G.V., M.L.S.), and National Institute on Drug Abuse, Bethesda (I.D.M.) - both in Maryland; the Department of Behavioral Science, University of Texas M.D. Anderson Cancer Center, Houston (P.M.C., J.D.R.); the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL (D.J.D.); the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (F.J.M.); and the Department of Psychiatry, Perelman School of Medicine, and Abramson Cancer Center, University of Pennsylvania, Philadelphia (A.A.S.)
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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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McRobbie H, Przulj D, Smith KM, Cornwall D. Complementing the Standard Multicomponent Treatment for Smokers With Denicotinized Cigarettes: A Randomized Trial. Nicotine Tob Res 2015; 18:1134-41. [PMID: 26045250 DOI: 10.1093/ntr/ntv122] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/29/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral support but do not address the sensory and behavioral aspects of smoking which may play a role in maintaining smoking behavior. Replacing such sensations temporarily after cessation may enhance treatment efficacy. We hypothesized that denicotinized cigarettes (DNCs), which have a very low nicotine content but provide these sensory and behavioral stimuli, could help alleviate urges to smoke and tobacco withdrawal symptoms and in turn enhance the efficacy of ST. METHODS Two hundred smokers seeking treatment received nine weekly behavioral support sessions and pharmacotherapy (100 used varenicline, 100 used nicotine replacement therapy). They were randomized on the target quit day to receive 280 DNCs (used ad libitum over 2 weeks in addition to ST) or ST alone. RESULTS Urge-to-smoke frequency (2.61 vs. 2.96, P = .03) but not strength (2.85 vs. 3.10, P = .20) in the first week of abstinence was significantly lower in DNC users versus ST alone. There were no differences in composite withdrawal scores between groups. Abstinence was significantly higher among DNC users versus ST alone at 1 (OR = 2.07; 95% CI: 1.63% to 3.70%) and 4 weeks (OR = 1.83; 95% CI: 1.05% to 3.21%), but not at 12 weeks (OR = 1.42; 95% CI: 0.79% to 2.55%). DNC use was a significant predictor of abstinence at 1 and 4 weeks (OR = 2.63; 95% CI: 1.40% to 4.93% and OR = 2.38; 95% CI: 1.26% to 4.46%), but not at 12 weeks. CONCLUSIONS Adding DNCs to ST has the potential to assist smokers early in their quit attempt, but research is needed to determine how best to utilize DNCs in treatment.
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Affiliation(s)
- Hayden McRobbie
- Tobacco Dependence Research Unit, UK Centre for Tobacco and Alcohol Studies, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Dunja Przulj
- Tobacco Dependence Research Unit, UK Centre for Tobacco and Alcohol Studies, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Katherine Myers Smith
- Tobacco Dependence Research Unit, UK Centre for Tobacco and Alcohol Studies, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Danielle Cornwall
- Tobacco Dependence Research Unit, UK Centre for Tobacco and Alcohol Studies, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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