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Cassidy RN, Tidey JW, Jackson KM, Cioe PA, Murphy SE, Krishnan-Sarin S, Hatsukami D, Colby SM. The Impact of Reducing Nicotine Content on Adolescent Cigarette Smoking and Nicotine Exposure: Results From a Randomized Controlled Trial. Nicotine Tob Res 2023; 25:918-927. [PMID: 36482794 PMCID: PMC10077938 DOI: 10.1093/ntr/ntac279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/13/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION As the science base around the potential benefits of a reduced-nicotine standard for cigarettes grows, information on the potential effects on adolescent smokers is a high priority. The aim of this randomized trial was to test the influence of 3-week exposure to reduced nicotine cigarettes in a sample of adolescent daily smokers. AIMS AND METHODS In this double-blind, two-arm, randomized controlled trial (NCT0258731), following a 1-week baseline, adolescent daily smokers not currently intending to quit (ages 15-19 years, n = 66 randomized) were urn randomized to use either very low nicotine content (VLNC; 0.4 mg/g; n = 33) or normal nicotine content (NNC, 15.8 mg/g; n = 33) research cigarettes for 3 weeks. Participants attended five study sessions at our clinical laboratory. The primary outcome was average total cigarettes smoked per day (CPD; including both study and non-study cigarettes) at week 3. RESULTS Stepwise regression results demonstrated that compared with NNC cigarettes (n = 31), assignment to VLNC cigarettes (n = 29), was associated with 2.4 fewer CPD on average than NNC assignment (p < .05) week 3 when controlling for covariates (p < .01, Cohen's d = 0.52 n = 60 completed all procedures). VLNC cigarettes were also associated with lower levels of craving reduction than NNC cigarettes (Questionnaire on Smoking Urges Factor 2, p < .05). No group differences were found for secondary outcomes. CONCLUSIONS Adolescent participants assigned to VLNC use for 3 weeks smoked fewer total CPD relative to the NNC group. Overall, data suggest that a VLNC policy would reduce cigarette smoking in adolescents who smoke, but high rates of incomplete adherence suggest that youth may seek alternative sources of nicotine in this scenario. IMPLICATIONS The US Food and Drug Administration may enact a reduced-nicotine product standard that would affect all commercially available cigarettes. One important population affected by this policy would be adolescents who smoke. This study, the first clinical trial of VLNC cigarettes in adolescents, demonstrates that adolescents switched to VLNC cigarettes for 3 weeks reduced their CPD relative to the normal-nicotine cigarette control group, without leading to increased respiratory symptoms or increased withdrawal. Biomarkers indicated the use of other sources of nicotine, suggesting that such a policy will need to consider approaches to assist in transitioning away from smoking.
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Affiliation(s)
- Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Dorothy Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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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: 3] [Impact Index Per Article: 1.5] [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.
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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
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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.
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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
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Krebs NM, Zhu J, Wasserman E, Kuprewicz R, Martinez DJ, Veldheer S, Livelsberger C, Modesto J, Reinhart L, Trushin N, Reilly SM, Liao J, Fazzi A, Bascom R, Richie JP, Foulds J, Horn K, Muscat JE. Switching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical Trial. Nicotine Tob Res 2021; 23:992-1001. [PMID: 33249498 PMCID: PMC8150128 DOI: 10.1093/ntr/ntaa247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Food and Drug Administration issued an advanced notice of proposed rulemaking for setting a product standard for nicotine levels in cigarettes, with an emphasis on minimally or non-addicting very low nicotine content (VLNC). METHODS A 33 week, two-arm, double-blind randomized trial conducted in Hershey, Pennsylvania, USA and Washington, DC, USA included adult daily cigarette smokers (≥5 cigarettes per day) with less than a college degree, and who had no plans to quit within the next six months. Participants were randomized to either reduced nicotine content (RNC) study cigarettes tapered every three weeks to a final VLNC (0.2 mg/cigarette) for six weeks or to usual nicotine content (UNC) study cigarettes (11.6 mg/cigarette). Outcomes included acceptability of study cigarettes measured by attrition (primary outcome), compliance, reduction in cigarette dependence and tobacco biomarkers, and post-intervention cessation. RESULTS The RNC (n = 122) versus UNC (n = 123) group had higher attrition (adjusted Hazard Ratio 3.4; 95% confidence interval [CI] 1.99 to 5.81). At the end of the intervention, cotinine levels were 50% lower in the RNC group (mean group difference -137 ng/mL; 95% CI -172, -102). The RNC group smoked fewer CPD (-4.1; 95% CI -6.44, -1.75) and had lower carbon monoxide levels (-4.0 ppm; 95% CI -7.7, -0.4). Forty seven percent (29/62) of the RNC group were biochemically-confirmed compliant with smoking VLNC cigarettes (mean cotinine = 8.9 ng/ml). At three month follow-up, only compliant VLNC smokers quit with an assisted quit attempt (N = 6/22, 27%). CONCLUSIONS This study supports a VLNC standard in cigarettes. IMPLICATIONS Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.
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Affiliation(s)
- Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Robin Kuprewicz
- Department of Psychiatry, Georgetown University, Washington, DC
| | - Diane J Martinez
- Public Health Division, Arlington County Department of Human Services, Arlington, VA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
- Department of Family and Community Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jennifer Modesto
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Samantha M Reilly
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Alyse Fazzi
- Department of Pharmacy, Investigational Drug Service Pharmacy, Penn State Health, Hershey, PA
| | - Rebecca Bascom
- Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Roanoke, VA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
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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.
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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
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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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7
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Do non-daily smokers compensate for reduced cigarette consumption when smoking very-low-nicotine-content cigarettes? Psychopharmacology (Berl) 2018; 235:3435-3441. [PMID: 30291402 PMCID: PMC6252121 DOI: 10.1007/s00213-018-5056-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/28/2018] [Indexed: 02/01/2023]
Abstract
RATIONALE The Food and Drug Administration is considering severely restricting the nicotine in cigarettes, to reduce smoking. A study showed that non-daily, intermittent smokers (ITS) randomized to very-low-nicotine-content cigarettes (VLNCCs) reduced their cigarette consumption. OBJECTIVES To assess whether increased smoking intensity of VLNCCs compensated for some of the reduced cigarette consumption. METHODS After a 2-week baseline smoking their own-brand cigarettes, 118 ITS were randomized to VLNCCs (~ 1 mg nicotine/g tobacco), and 120 to normal-nicotine-content cigarettes (NNCCs; ~ 16 mg/g) for 10 weeks. Laboratory measures of smoking intensity-total puff volume and carbon monoxide (CO) boost-assessed single cigarettes smoked in up to three laboratory topography sessions. Field measures assessed returned cigarette butts, averaged over up to five 2-week intervals: the mass of tobacco burned (computed from residual mass of butts) and the intensity of smoking (by scanning of returned filters). Analysis was by mixed model random effects models using baseline values as covariates. RESULTS ITS in the VLNCC group puffed less smoke in topography sessions (-38.50 mL [-75.21, -1.78]; p < 0.04), but showed no difference in CO boost. Participants in the VLNCC group burned 0.02 [0.04, 0.002] grams less tobacco per cigarette (p < 0.03). Analysis of filters showed their smoking intensity declined over time, compared to NNCC participants (p < 0.04). "Cheating" by smoking normal cigarettes did not moderate these effects. CONCLUSIONS ITS did not increase their smoking intensity when switched to VLNCCs; indeed, their smoking intensity decreased. Reductions in cigarette consumption seen when ITS are switched to VLNCCs were not compensated by increased smoking intensity.
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Abstract
This Special Issue of Preventive Medicine (PM) is the 5th in a series on behavior change, health, and health disparities. Unhealthy behavior patterns (i.e., lifestyle choices) including cigarette smoking and other substance abuse, physical inactivity, unhealthy food choices, and non-adherence with recommended medical regimens, undermine U.S. population health by increasing risk for chronic disease and premature death. This Special Issue brings together scholarly contributions from the emerging area of tobacco regulatory science to examine current topics of critical importance to reducing the burden of cigarette smoking on U.S. population health. More specifically, three related topics are examined including (a) the potential for reducing smoking by adopting a national policy that would cap the nicotine content of cigarettes at minimally-addictive levels; (b) increasing scientific understanding of cigarette smoking and other tobacco use among populations that are especially vulnerable to initiating smoking, tobacco addiction, and its adverse health consequences; and (c) the potential of a harm-reduction strategy for reducing the burden of smoking by advocating that those who are unwilling or unable to quit nicotine use substitute electronic cigarettes or other non-combusted sources of nicotine for cigarettes in order to avoid exposure to the other toxins in tobacco smoke that are most responsible for smoking morbidity and mortality. While tremendous progress has been made in reducing overall U.S. smoking prevalence and its adverse health impacts, more needs to be done. This Special Issue offers some ideas that have the potential to make a substantive contribution towards that goal.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont.
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