1
|
Foulds J, Veldheer S, Pachas G, Hrabovsky S, Hameed A, Allen SI, Cather C, Azzouz N, Yingst J, Hammett E, Modesto J, Krebs NM, Lester C, Trushin N, Reinhart L, Wasserman E, Zhu J, Liao J, Muscat JE, Richie JP, Evins AE. The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial. PLoS One 2022; 17:e0275522. [PMID: 36322562 PMCID: PMC9629593 DOI: 10.1371/journal.pone.0275522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The U.S. Food and Drug Administration and the government of New Zealand have proposed a reduction of the nicotine content in cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders. METHODS In a randomized controlled parallel group trial conducted at two sites in the USA (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with a current (n = 118) or lifetime (n = 70) anxiety or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned (1:1) to smoke either Usual Nicotine Content (UNC) (11.6 mg nicotine/cigarette) research cigarettes, or Reduced Nicotine Content (RNC) research cigarettes where the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice to either receive assistance to quit smoking, receive free research cigarettes, or resume using their own cigarette brand during a 12-week follow-up period. Main outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior and dependence and severity of psychiatric symptoms. The pre-registered primary outcome was plasma cotinine. RESULTS A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to the lowest nicotine content cigarettes, compared to smokers in the UNC group, at the last randomized visit the RNC group had significantly lower plasma cotinine (metabolite of nicotine): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urine NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon-monoxide, cigarette consumption, and cigarette dependence were also significantly lower in the RNC group than the UNC group. No between-group differences were found on a range of other biomarkers (e.g. 8-isoprostanes) or health indicators (e.g. blood pressure), or on 5 different psychiatric questionnaires, including the Kessler K6 measure of psychological distress. At the end of the subsequent 12-week treatment choice phase, those randomized to the RNC group were more likely to have quit smoking, based on initial intent-to-treat sample, n = 188 (18.1% RNC v 4.3% UNC, p = 0.004). CONCLUSION Reducing nicotine content in cigarettes to very low levels reduces some toxicant exposures and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health. TRIAL REGISTRATION TRN: NCT01928758, registered August 21, 2013.
Collapse
Affiliation(s)
- Jonathan Foulds
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Susan Veldheer
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Shari Hrabovsky
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- Ross and Carol Nese College of Nursing, Penn State University, State College, PA, United States of America
| | - Ahmad Hameed
- Department of Psychiatry, Pennsylvania State University—College of Medicine, Hershey, PA, United States of America
| | - Sophia I. Allen
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Corinne Cather
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Nour Azzouz
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Jessica Yingst
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Erin Hammett
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Jennifer Modesto
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Nicolle M. Krebs
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Courtney Lester
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Neil Trushin
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Lisa Reinhart
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Emily Wasserman
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Junjia Zhu
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Jason Liao
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Joshua E. Muscat
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - John P. Richie
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
2
|
Lin W, Hobkirk AL, Zhu J, Krebs NM, Hayes JE, Richie JP, Liao J, Horn K, Foulds J, Muscat JE. Effect of menthol on nicotine reduction: Pooled results from two double-blind randomized controlled trials. Brain Res Bull 2022; 189:131-138. [PMID: 36038015 PMCID: PMC10650975 DOI: 10.1016/j.brainresbull.2022.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Menthol upregulates nicotinic acetylcholine receptors and is associated with tobacco dependence. The effects of menthol when smoking cigarettes with varying low nicotine content up to 98 % (e.g., non-addicting) less than commercial cigarettes is not well understood. The U.S. Food and Drug Administration is considering two tobacco product standards in cigarettes including banning menthol and reducing nicotine content. These new standards have the potential to significantly reduce smoking initiation and maintenance by limiting the mechanistic effects of nicotine and menthol on the brain. METHODS We conducted two parallel randomized clinical trials of gradually reduced nicotine in cigarettes from 11.6 mg down to 0.2 mg nicotine/cigarette (very low nicotine content; VLNC) vs. usual nicotine content (11.6 mg; UNC) over an 18-week period in people who smoke cigarettes with low socioeconomic status (SES) and mental health conditions. RESULTS Compared to UNC, VLNC was associated with significant reductions in cotinine, cigarettes per day, expired carbon monoxide levels, nicotine dependence and symptomology. These associations did not differ between menthol and non-menthol cigarettes, except people who smoke menthol cigarettes had less of a cotinine reduction in the SES trial. The pooled odds ratio of being adherent with using only VLNC study cigarettes in the gradual nicotine reduction arm for people who smoke non-menthol vs. menthol cigarettes was 2.6 (95 % CI:1.0, 6.4; p-value: 0.04). CONCLUSIONS When nicotine is lowered to non-addicting levels, the results indicate an independent effect of menthol on the need to sustain nicotine intake in addicted people who smoke cigarettes.
Collapse
Affiliation(s)
- Wenxue Lin
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Junjia Zhu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Nicolle M Krebs
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - John E Hayes
- Sensory Evaluation Center, Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, United States; Department of Food Science, College of Agricultural Sciences, Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, United States
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Jason Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Roanoke, VA 24016, United States
| | - Jonathan Foulds
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Joshua E Muscat
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| |
Collapse
|
3
|
Krebs NM, Zhu J, Wasserman E, Kuprewicz R, Martinez DJ, Veldheer S, Livelsberger C, Modesto J, Reinhart L, Trushin N, Reilly SM, Liao J, Fazzi A, Bascom R, Richie JP, Foulds J, Horn K, Muscat JE. Switching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical Trial. Nicotine Tob Res 2021; 23:992-1001. [PMID: 33249498 PMCID: PMC8150128 DOI: 10.1093/ntr/ntaa247] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Food and Drug Administration issued an advanced notice of proposed rulemaking for setting a product standard for nicotine levels in cigarettes, with an emphasis on minimally or non-addicting very low nicotine content (VLNC). METHODS A 33 week, two-arm, double-blind randomized trial conducted in Hershey, Pennsylvania, USA and Washington, DC, USA included adult daily cigarette smokers (≥5 cigarettes per day) with less than a college degree, and who had no plans to quit within the next six months. Participants were randomized to either reduced nicotine content (RNC) study cigarettes tapered every three weeks to a final VLNC (0.2 mg/cigarette) for six weeks or to usual nicotine content (UNC) study cigarettes (11.6 mg/cigarette). Outcomes included acceptability of study cigarettes measured by attrition (primary outcome), compliance, reduction in cigarette dependence and tobacco biomarkers, and post-intervention cessation. RESULTS The RNC (n = 122) versus UNC (n = 123) group had higher attrition (adjusted Hazard Ratio 3.4; 95% confidence interval [CI] 1.99 to 5.81). At the end of the intervention, cotinine levels were 50% lower in the RNC group (mean group difference -137 ng/mL; 95% CI -172, -102). The RNC group smoked fewer CPD (-4.1; 95% CI -6.44, -1.75) and had lower carbon monoxide levels (-4.0 ppm; 95% CI -7.7, -0.4). Forty seven percent (29/62) of the RNC group were biochemically-confirmed compliant with smoking VLNC cigarettes (mean cotinine = 8.9 ng/ml). At three month follow-up, only compliant VLNC smokers quit with an assisted quit attempt (N = 6/22, 27%). CONCLUSIONS This study supports a VLNC standard in cigarettes. IMPLICATIONS Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.
Collapse
Affiliation(s)
- Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Robin Kuprewicz
- Department of Psychiatry, Georgetown University, Washington, DC
| | - Diane J Martinez
- Public Health Division, Arlington County Department of Human Services, Arlington, VA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
- Department of Family and Community Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jennifer Modesto
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Samantha M Reilly
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Alyse Fazzi
- Department of Pharmacy, Investigational Drug Service Pharmacy, Penn State Health, Hershey, PA
| | - Rebecca Bascom
- Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Roanoke, VA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| |
Collapse
|
4
|
Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, Te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database Syst Rev 2021; 3:CD013522. [PMID: 33687070 PMCID: PMC8121093 DOI: 10.1002/14651858.cd013522.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. OBJECTIVES To examine the association between tobacco smoking cessation and change in mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow-up. Secondary outcomes included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS-I tool. For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). MAIN RESULTS We included 102 studies representing over 169,500 participants. Sixty-two of these were identified in the updated search for this review and 40 were included in the original version of the review. Sixty-three studies provided data on change in mental health, 10 were included in meta-analyses of incidence of mental health disorders, and 31 were synthesised narratively. For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD -0.28, 95% CI -0.43 to -0.13; 15 studies, 3141 participants; I2 = 69%; low-certainty evidence); depression symptoms: (SMD -0.30, 95% CI -0.39 to -0.21; 34 studies, 7156 participants; I2 = 69%' very low-certainty evidence); mixed anxiety and depression symptoms (SMD -0.31, 95% CI -0.40 to -0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence). These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time-varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD -0.19, 95% CI -0.34 to -0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%). AUTHORS' CONCLUSIONS Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.
Collapse
Affiliation(s)
- Gemma Mj Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amanda Farley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | | | - Katherine Sawyer
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | | | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Naomi King
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Chloe Burke
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Kamens HM, Silva CP, Nye RT, Miller CN, Singh N, Sipko J, Trushin N, Sun D, Branstetter SA, Muscat JE, Richie JP, Foulds J. Pharmacokinetic Profile of Spectrum Reduced Nicotine Cigarettes. Nicotine Tob Res 2020; 22:273-279. [PMID: 30892637 DOI: 10.1093/ntr/ntz045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Spectrum research cigarettes have been developed with varying nicotine content for use in studies evaluating the effects of a regulatory policy reducing the permissible nicotine content in cigarettes. This study aimed to characterize the nicotine pharmacokinetic profile of Spectrum cigarettes. METHODS Twelve daily smokers attended four sessions and had blood nicotine, exhaled carbon monoxide, and subjective effects measured before and after smoking either a single cigarette of their preferred brand or high (10.9 mg/cigarette), medium (3.2 mg/cigarette), or low (0.2 mg/cigarette) nicotine content Spectrum research cigarettes, in a double-blind design with order counterbalanced. RESULTS The boost in blood nicotine concentration was dose-dependent, with a boost of 0.3, 3.9, and 17.3 ng/mL for low-, medium-, and high-nicotine content Spectrum cigarettes. The high dose Spectrum had a similar nicotine boost to the "preferred brand" cigarettes (19 ng/mL). Subjects took longer puffs on the low nicotine cigarettes, but smoked these cigarettes faster than other cigarette types. High nicotine Spectrum cigarettes reduced the urge to smoke more than other cigarette types. CONCLUSIONS This study shows that Spectrum research cigarettes produce blood nicotine absorption in a dose-dependent manner, and therefore, are appropriate for use in studies of nicotine reduction in cigarettes. IMPLICATIONS This is the first study to determine the pharmacokinetic profile of Spectrum reduced nicotine content research cigarettes following an overnight abstinence. These data could provide evidence to regulatory agencies about the effects of reduced nicotine cigarettes when considering regulations on tobacco reduction.
Collapse
Affiliation(s)
- Helen M Kamens
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA.,Penn State Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Constanza P Silva
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Russell T Nye
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Carley N Miller
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Nayantara Singh
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Joseph Sipko
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Neil Trushin
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA
| | - Dongxiao Sun
- Department of Pharmacology, Pennsylvania State University, Hershey, PA.,Penn State Mass Spectrometry Core Facility, Pennsylvania State University, Hershey, PA
| | - Steven A Branstetter
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA.,Penn State Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Joshua E Muscat
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.,Department of Public Health Sciences, Pennsylvania State University, Hershey, PA
| | - John P Richie
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.,Department of Public Health Sciences, Pennsylvania State University, Hershey, PA.,Department of Pharmacology, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.,Department of Public Health Sciences, Pennsylvania State University, Hershey, PA.,Department of Psychiatry, Pennsylvania State University, Hershey, PA
| |
Collapse
|
6
|
Allen SI, Wasserman E, Veldheer S, Yingst J, Hrabovsky S, Liao J, Krebs NM, Horn K, Reinhart L, Modesto J, Putt K, Evins AE, Muscat JE, Richie JP, Foulds J. Characteristics of Adult Cigarette Smokers Who "Relight" and the Effects of Exposure to Tobacco Smoke Constituents. Nicotine Tob Res 2020; 21:1206-1212. [PMID: 29982710 DOI: 10.1093/ntr/nty138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/29/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION About half of smokers relight their cigarette, a habit that is a risk factor for chronic bronchitis and possibly lung cancer. Little is known about the characteristics of smokers who relight and their dependence on nicotine. It is unknown whether relighting affects exposure to tobacco smoke constituents. This study examined the characteristics of relighters of usual brand cigarettes and whether relighting affects exposure to selected tobacco smoke constituents. METHODS We explored relighting status and frequency, using baseline data from 248 adult smokers participating in studies of reduced nicotine cigarettes in relation to demographic and cigarette characteristics, smoking behaviors, nicotine dependence, biomarkers of exposure (exhaled carbon monoxide, blood cotinine), and biomarkers of oxidative stress (ratio of oxidized/reduced glutathione). RESULTS 69.4% (n = 172) of subjects reported relighting, and they relit an average of five cigarettes out of 20. Both relighters and non-relighters smoked a mean of 20 cigarettes per day (p = .6). Relighting was significantly associated with higher nicotine dependence, use of longer rod cigarettes, older age, lower income, and unemployment. There were no significant associations between relighting and blood cotinine, exhaled carbon monoxide or measures of oxidized/reduced blood glutathione. CONCLUSIONS The majority of subjects were relighters, who had higher levels of nicotine dependence than non-relighters. Relighters had similar levels of plasma cotinine and exhaled carbon monoxide to non-relighters. IMPLICATIONS No study has compared the cigarette characteristics and biomarkers of exposure of adult cigarette smokers who relight with those who do not. Relighting behavior was common in our sample and was associated with low income, not currently working, higher nicotine dependence, cigarette rod length, daily cigarette use years, and a lifetime history of depressed mood.
Collapse
Affiliation(s)
- Sophia I Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jessica Yingst
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Kimberly Horn
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Kayla Putt
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| |
Collapse
|
7
|
Hrabovsky SM, Midya V, Lester C, Veldheer S, Yingst JM, Allen SI, Krebs NM, Liao J, Reinhart L, Modesto J, Evins AE, Richie JP, Muscat JE, Horn K, Foulds J. Effect of Cigarette Rod Length on Smokers Switching to SPECTRUM Cigarettes. Am J Health Behav 2019; 43:380-392. [PMID: 30808477 DOI: 10.5993/ajhb.43.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Cigarettes vary in rod length but are generally thought of as a constant unit. In this study, we evaluated whether the rod length of participants' usual brand cigarettes affected their perceptions and smoking habits when switching to SPECTRUMs. Methods: Data were analyzed for 341 participants smoking their own brand cigarettes for one week and after switching to normal nicotine content (11.6 mg) SPECTRUMs for 2 weeks. Changes in perceptions of cigarette attributes and biomarkers of smoke exposure were evaluated using linear mixed models among 3 groups: usual length short (ULS, 72 mm); medium/king (ULM, ~84 mm); and long (ULL ≥ 100 mm). Results: Among the 3 cigarette length groups, only ULL smokers' rated SPECTRUMs significantly less strong, harder to draw, lower in taste, and lower in enjoyment (p < .03) compared to usual brand. Among all groups, satisfaction was significantly lower for SPECTRUMs (p < .02). Cigarettes per day (CPD) increased significantly more for ULL (+4.75 CPD) as compared to ULM (+1.38 CPD) (p < .001). When switching to SPECTRUMs, cotinine-per-cigarette decreased among all groups, and exhaled carbon monoxide increased significantly in ULL and ULM smokers (p < .001). Conclusion: People who smoked long cigarettes had the largest changes in perceptions and use when switching to SPECTRUM research cigarettes.
Collapse
Affiliation(s)
- Shari M. Hrabovsky
- Assistant Research Professor, Penn State College of Nursing, Hershey, PA;,
| | - Vishal Midya
- Pre-Doctoral Scholar, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Courtney Lester
- Research Coordinator, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Susan Veldheer
- Assistant Professor, Department of Community and Family Medicine, Penn State College of Medicine, Hershey, PA
| | - Jessica M. Yingst
- Pre-doctoral Scholar, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Sophia I. Allen
- Postdoctoral Scholar, De- partment of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Nicolle M. Krebs
- Project Manager, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jason Liao
- Professor of Public Health Sciences and Biostatistics Core Director, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Lisa Reinhart
- Research Technologist, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jennifer Modesto
- Laboratory Manager, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - A. Eden Evins
- Director of the Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - John P. Richie
- Professor of Public Health Sciences and Pharmacology, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Joshua E. Muscat
- Professor of Public Health Sciences, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kimberly Horn
- Associate Dean, Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Jonathan Foulds
- Professor of Public Health Sciences and Psychiatry, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| |
Collapse
|
8
|
Estimation of compliance with exclusive smoking of very low nicotine content cigarettes using plasma cotinine. Prev Med 2018; 117:24-29. [PMID: 29626556 PMCID: PMC6422348 DOI: 10.1016/j.ypmed.2018.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 01/04/2023]
Abstract
Regulations requiring a reduction of the nicotine content in cigarettes to minimally addictive levels could significantly reduce the public health impact of cigarette smoking. Clinical trials evaluating this strategy are ongoing and methods have been developed to use nicotine biomarkers to estimate compliance with use of very low nicotine content cigarettes (VLNCs). To date, these methods have not considered the potential contribution of nicotine absorption from environmental tobacco smoke (ETS) among research participants. This study used data from 100 randomly selected study completers in ongoing clinical trials of VLNCs (50 randomized to Usual Nicotine Content Cigarettes (UNCs) and 50 to VLNCs) to assess the use of plasma cotinine to estimate compliance. Plasma cotinine and smoking behavior were recorded at baseline after 2 weeks smoking UNC cigarettes, and then after 18 weeks of either continuing smoking UNCs or reducing the nicotine content such that the last 6 weeks comprised smoking VLNCs. Plasma cotinine remained stable (267 ng/ml) in the UNC group but reduced to 93 ng/ml in the VLNC group (p < 0.01). Compliance with smoking VLNCs was first estimated by comparing the cotinine per cigarette on VLNCs with UNCs after allowing for potential compensatory smoking. We found that 29 (58%) of the VLNC group were compliant. Adjusting for potential ETS exposure estimated 32 (64%) to be compliant. This latter group (n = 32) had a mean plasma cotinine on VLNCs of 7 ng/ml (range = 3-16.4 ng/ml). Adjusting for potential ETS exposure may improve identification of participants who plausibly complied with exclusive VLNC use.
Collapse
|
9
|
Tidey JW, Davis DR, Miller ME, Pericot-Valverde I, Denlinger-Apte RL, Gaalema DE. Modeling nicotine regulation: A review of studies in smokers with mental health conditions. Prev Med 2018; 117:30-37. [PMID: 30343684 PMCID: PMC7467778 DOI: 10.1016/j.ypmed.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 01/02/2023]
Abstract
Smokers with mental health conditions (MHCs) lose approximately 15 years of life relative to non-smokers without MHCs, of which two-thirds are attributable to smoking. The Food and Drug Administration (FDA) recently announced a new regulatory strategy for tobacco that includes a reduction in the nicotine content of cigarettes sold in the US to a minimally-addictive level. This action could improve cessation rates in smokers with MHCs by reducing their dependence on nicotine. However, nicotine reduction also could have unintended negative consequences in smokers with MHCs. Thus, it is important to conduct randomized controlled trials to investigate the potential effects of nicotine reduction in smokers with MHCs. Several studies of the acute or extended effects of nicotine reduction in smokers with emotional disorders or serious mental illness have been recently completed or are underway. Studies to date indicate that when smokers with MHCs are switched, under randomized, double-blind conditions, to cigarettes with very low nicotine content, they reduce their cigarette intake, with minimal or no effects on withdrawal, psychiatric symptoms, or compensatory smoking. However, some deleterious effects of nicotine reduction on cognitive performance measures in smokers with schizophrenia have been observed, which are offset by providing concurrent nicotine replacement. We review these studies and provide suggestions for potentially increasing the effectiveness of a nicotine reduction strategy for reducing smoking in people with MHCs. The research described was conducted in the United States in 2010-2018.
Collapse
Affiliation(s)
- Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, USA.
| | | | - Mollie E Miller
- Department of Behavioral and Social Sciences, Brown University, USA
| | | | | | | |
Collapse
|
10
|
Kazi A, Fazzi A, Krebs NM, Merchlinski AJ, Kline B, Veldheer S, Richie JP, Foulds J, Lane T, Donny EC, Muscat JE. Cigarette Management System: An operating procedures guide to obtaining and managing investigational tobacco products for regulatory science research. Contemp Clin Trials Commun 2018; 11:69-74. [PMID: 30023460 PMCID: PMC6024157 DOI: 10.1016/j.conctc.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/06/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022] Open
Abstract
Investigational tobacco products, specifically variable nicotine content research cigarettes (SPECTRUM), are available through the National Institute of Drug Abuse Drug Supply Program. Randomized controlled trials using research cigarettes are intended to support tobacco regulatory science research. The current paper provides an in-depth look into managing research cigarettes for two multi-site clinical trials and the design of a computer-based Cigarette Management System (CMS). The paper provides guidance intended for any investigator using similar products on the operating procedures under Good Clinical Practice standards and describes features of the CMS. The CMS and procedures described have been field tested for the past three years and have dispensed over 160,000 cigarette packs to participants. The CMS can accommodate a range of practical issues with real-world study implementation making it a robust application that is scalable to any study.
Collapse
Affiliation(s)
- Abid Kazi
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Alyse Fazzi
- Department of Pharmacy, Investigational Drug Service Pharmacy, Penn State Health, Hershey, PA, United States
| | - Nicolle M Krebs
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Aimee J Merchlinski
- Department of Public Health Sciences, Research Application Development, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Brenda Kline
- Department of Public Health Sciences, Research Application Development, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Susan Veldheer
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - John P Richie
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Jonathan Foulds
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Tonya Lane
- Center for the Evaluation of Tobacco Products, University of Minnesota, Minneapolis, MN, United States
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joshua E Muscat
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| |
Collapse
|
11
|
Acceptability of SPECTRUM Research Cigarettes among Participants in Trials of Reduced Nicotine Content Cigarettes. TOB REGUL SCI 2018; 4:573-585. [PMID: 30662929 DOI: 10.18001/trs.4.1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives SPECTRUM research cigarettes (SPECTRUMs) are being used in trials evaluating the effects of switching to reduced nicotine content (RNC) cigarettes. Because smokers have a high brand affinity, we evaluated if they were willing to switch and continue smoking normal nicotine content (NNC) SPECTRUMs. Methods We asked smokers (N = 341) to rate their own brand of cigarettes and NNC SPECTRUMs (after 2 weeks of use) using subjective measures including satisfaction, reward, taste, and craving reduction. We measured plasma cotinine, exhaled carbon monoxide (CO), and cigarettes per day (CPD), and recorded reasons for dropping out. Results After 2 weeks, 95% of participants chose to continue using SPECTRUMs for an additional 18 weeks. Moreover, 67% said SPECTRUMs were as good as or better than their own brand, and 65% said they would consider purchasing them. Ratings of satisfaction, reward, and craving reduction were 10%-15% lower on SPECTRUMs than on their own brand (p < .01). There were no differences in these ratings between menthol and non-menthol smokers. Conclusions Menthol and non-menthol SPECTRUMs are acceptable to smokers. Lower SPECTRUM ratings were likely due to brand switching and did not hinder study retention.
Collapse
|
12
|
Das S, Prochaska JJ. Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders. Expert Rev Respir Med 2017; 11:841-850. [PMID: 28756728 PMCID: PMC5790168 DOI: 10.1080/17476348.2017.1361823] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.
Collapse
Affiliation(s)
- Smita Das
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|