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Reynolds RM, Popova L, Ashley DL, Henderson KC, Ntansah CA, Yang B, Hackworth EE, Hardin J, Thrasher J. Messaging about very low nicotine cigarettes (VLNCs) to influence policy attitudes, harm perceptions and smoking motivations: a discrete choice experiment. Tob Control 2024; 33:325-332. [PMID: 36171147 PMCID: PMC10043050 DOI: 10.1136/tc-2022-057577] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To reduce smoking and the harms it causes, countries, including the USA, are considering policies to reduce nicotine in combustible tobacco to minimally addictive levels. Effective messages about very low nicotine cigarettes (VLNCs) and this policy are crucial in combating misperceptions threatening the policy's effectiveness. DATA AND METHODS A discrete choice experiment assessed messages about VLNCs. Participants were 590 adults who smoked exclusively, 379 adults who both smoked and used e-cigarettes, 443 adults who formerly smoked and 351 young adults who never smoked (total n=1763). Seven message attributes were varied systematically (source, harm, chemicals, nicotine, satisfaction, addictiveness and quitting efficacy). Outcomes were selection of messages that generated the most positive attitude towards reduced nicotine policy, the greatest perceived harmfulness of VLNCs, and most strongly motivated quitting and initiating behaviour for VLNCs. RESULTS Information about specific harms and chemicals of VLNCs had the largest effects on selection of messages as eliciting more negative attitudes towards VLNCs policy, increasing perceived VLNC harmfulness, increasing motivation to quit VLNCs and decreasing motivation to try VLNCs. Messages with information about quitting efficacy were selected as more motivating to quit among those who smoke, but also more motivating to try VLNCs among those who do not smoke. CONCLUSION Harm and chemical information can be prioritised to ensure VLNCs are not misperceived as less harmful than regular cigarettes. Messages about increased quitting efficacy and reduced addictiveness associated with VLNCs may backfire if presented to those who do not smoke.
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Affiliation(s)
- Reed M Reynolds
- Communication Department, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Charity A Ntansah
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Emily E Hackworth
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James Hardin
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Zhang M, Wang J, Edmiston J. Underreporting of non-study cigarette use by study participants confounds the interpretation of results from ambulatory clinical trial of reduced nicotine cigarettes. Harm Reduct J 2024; 21:35. [PMID: 38331789 PMCID: PMC10854148 DOI: 10.1186/s12954-024-00953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND As part of its comprehensive plan to significantly reduce the harm from tobacco products, the US Food and Drug Administration is establishing a product standard to lower nicotine in conventional cigarettes to make them "minimally addictive or non-addictive". Many clinical studies have investigated the potential impact of such a standard on smoking behavior and exposure to cigarette constituents. These ambulatory studies required participants who smoke to switch to reduced nicotine study cigarettes. In contrast to clinical trials on pharmaceuticals or medical devices, participants had ready access to non-study conventional nicotine cigarettes and high rates of non-study cigarette use were consistently reported. The magnitude of non-compliance, which could impact the interpretation of the study results, was not adequately assessed in these trials. METHODS We conducted a secondary analysis of data from a large, randomized trial of reduced nicotine cigarettes with 840 participants to estimate the magnitude of non-compliance, i.e., the average number of non-study cigarettes smoked per day by study participants assigned to reduced nicotine cigarettes. Individual participants' non-study cigarette use was estimated based on his/her urinary total nicotine equivalent level, the nicotine content of the study cigarette assigned and the self-reported number of cigarettes smoked, using a previously published method. RESULTS Our analysis showed that (1) there is a large variation in the number of non-study cigarettes smoked by participants within each group (coefficient of variation 90-232%); (2) participants in reduced nicotine cigarette groups underreported their mean number of non-study cigarettes smoked per day by 85-91%; and (3) the biochemical-based estimates indicate no reduction in the mean number of total cigarettes smoked per day for any group assigned to reduced nicotine cigarettes after accounting for non-study cigarettes. CONCLUSIONS High levels of non-compliance, in both the rate and magnitude of non-study cigarette use, are common in ambulatory reduced nicotine cigarette trials where participants have access to conventional nicotine non-study cigarettes. The potential impact of high non-compliance on study outcomes should be considered when interpreting the results from such ambulatory studies.
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Affiliation(s)
- Mingda Zhang
- Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA, 23219, USA.
| | - Jingzhu Wang
- Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA, 23219, USA
| | - Jeffery Edmiston
- Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA, 23219, USA
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Strickland JC, Gelino BW, Naudé GP, Harbaugh JC, Schlitzer RD, Mercincavage M, Strasser AA, Johnson MW. Effect of nicotine expectancy and nicotine dose reduction on cigarette demand, withdrawal alleviation, and puff topography. Drug Alcohol Depend 2024; 254:111042. [PMID: 38086213 PMCID: PMC10872246 DOI: 10.1016/j.drugalcdep.2023.111042] [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: 10/10/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Current FDA plans include proposed nicotine reduction mandates by the end of 2023. Most research on reduced nicotine cigarettes has been dose-blinded, while a mandate would be known to the public. Few laboratory studies have examined specifically how low nicotine content labeling impacts behavioral response. The purpose of this within-subject, balanced-placebo, human laboratory study was to evaluate the main and interactive effects of nicotine dose expectancy and dose reduction on cigarette reinforcement, withdrawal alleviation, and puff topography. METHODS Participants who smoke daily (N=21; 9 female) completed one practice and four experimental sessions in which expectancy (labeled "average" versus "very low" nicotine) and nicotine dose (0.80mg versus 0.03mg yield) were manipulated. Participants in acute withdrawal sampled experimental cigarettes followed by withdrawal alleviation and puff topography measures. Cigarette demand was measured using an incentivized purchase task. Analyses evaluated main and interactive effects of expectancy and nicotine dose. RESULTS Nicotine dose manipulation produced expected physiological effects (e.g., heart rate increases) and both reduced nicotine dose and expectation manipulations reduced perceived nicotine content. Expectation of reduced nicotine alone or in combination with reduced nicotine dose did not alter demand, withdrawal alleviation, or topography. Effective withdrawal alleviation was observed in all conditions. CONCLUSIONS These data inform nicotine regulation policy by suggesting limited compensatory harms caused by reduced nicotine expectations. The minimal acute effects of reduced nicotine expectancy or exposure on demand suggests that reduced nicotine standards are likely to generate their greatest public health benefit through the slowing of newly initiating cigarette smoking.
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Affiliation(s)
- Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Brett W Gelino
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gideon P Naudé
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica C Harbaugh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebekah D Schlitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa Mercincavage
- Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, PA, USA
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Oncken C, Litt MD, Thurlow S, Mead-Morse EL, Wang L, Hatsukami DK. Manipulation of Menthol and Nicotine Content in Cigarettes: Effects on Smoking Behavior and Toxicant Exposure in Women Menthol Smokers. Nicotine Tob Res 2023; 25:665-673. [PMID: 36156108 PMCID: PMC10032200 DOI: 10.1093/ntr/ntac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to determine the effects of smoking and other outcomes of assigning cigarettes with reduced nicotine and/or no menthol to female menthol smokers. AIMS AND METHODS Nontreatment-seeking female menthol smokers (N = 263) participated in a randomized controlled trial in which levels of menthol and nicotine in cigarettes were manipulated using experimental cigarettes. After a baseline period, participants were assigned to the following conditions for 6 weeks: (1) their own brand of cigarette (conventional nicotine with menthol), (2) a conventional nicotine cigarette with no menthol, (3) a cigarette with reduced nicotine (RNC) with menthol, or (4) a RNC cigarette and no menthol. Participants then returned to using their own brand and were followed for another 6 weeks. Outcomes included cigarettes smoked, biomarkers of exposure, and dependence measures. RESULTS Results indicated that, after an initial increase, rates of smoking of all three experimental cigarettes were at or below baseline rates of smoking of one's own brand. Levels of biomarkers also decreased during the experimental phase but rebounded somewhat after participants resumed smoking their own brand. There was evidence that the overall amount of smoking decreased similarly among women who switched to non-menthol and/or RNC cigarettes. CONCLUSIONS These results suggest that no detrimental effect will occur in nicotine or toxicant exposure levels with a ban on characterizing menthol and/or a product standard on nicotine content in cigarettes. IMPLICATIONS The implication of this work is that there would be no risk to women menthol smokers associated with regulations restricting nicotine and eliminating menthol in cigarettes.
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Affiliation(s)
- Cheryl Oncken
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Mark D Litt
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
- University of Connecticut School of Dental Medicine, Farmington, CT 06030, USA
| | - Sheila Thurlow
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Erin L Mead-Morse
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Lanqing Wang
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Duong HT, Loud EE, Thrasher JF, Henderson KC, Ashley DL, Popova L. 'It brings light to what you really put into your body': a focus group study of reactions to messages about nicotine reduction in cigarettes. Tob Control 2022; 31:649-654. [PMID: 33863835 PMCID: PMC8521550 DOI: 10.1136/tobaccocontrol-2020-056312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence. METHODS We designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April-May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach. FINDINGS Exclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful. CONCLUSIONS Messages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.
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Affiliation(s)
- Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, Georgia, USA
| | - Emily E Loud
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Henderson KC, Loud EE, Duong HT, Reynolds RM, Yang B, Ntansah CA, Ashley DL, Thrasher JF, Popova L. Perceptions of Nicotine Reduction Policy in the United States: A Qualitative Study. Nicotine Tob Res 2022; 24:1422-1429. [PMID: 35312014 PMCID: PMC9356678 DOI: 10.1093/ntr/ntac071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/26/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Several countries are considering a reduced nicotine policy that would make cigarettes minimally or nonaddictive. This qualitative study documents reactions to the policy that should be addressed by future communication efforts. METHODS In 2020, we recruited participants in Atlanta, GA and San Francisco, CA (27 people who exclusively smoke, 25 who dual use cigarettes and e-cigarettes, 32 who formerly smoked, and 31 young adults who do not smoke). We held 16 focus groups: 2 focus groups for each smoking status in each city. Participants viewed messages about very low nicotine content cigarettes (VLNCs) and were asked about their reactions to each message and their overall response to the reduced nicotine policy. RESULTS While responses to the policy were predominantly positive, focus group discussion also revealed concerns, questions, and misunderstandings (referred to here collectively as "perceptions") that may need to be addressed if a reduced nicotine policy is enacted. Participants expressed perceptions related to the policy intent, including that the FDA has ulterior motives, adoption/ implementation, including that nicotine would have to be replaced with other chemicals if removed or that the policy would be unfeasible to implement, and effectiveness, including concern that VLNCs would still be addictive or the policy would backfire. CONCLUSIONS Addressing perceptions about reduced nicotine policy intent, adoption/implementation, and effectiveness could be key in creating public support and political motivation to move forward with such a policy. Countries contemplating adopting such a policy should consider pairing it with communications that address these perceptions. IMPLICATIONS This study is one of very few to use qualitative methods to explore potentially problematic perceptions about nicotine reduction policy among US adults. Results illuminated new policy-specific concerns, questions, and misunderstandings about the reduced nicotine policy intent, adoption/implementation, and effectiveness. Identifying, studying, and addressing relevant perceptions may play a key role in generating support in countries contemplating such a policy.
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Affiliation(s)
| | | | - Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, GA, USA
| | - Reed M Reynolds
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ, USA
| | - Charity A Ntansah
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lucy Popova
- Corresponding Author: Lucy Popova, PhD, School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA 30302, USA. Telephone: 404-413-9338; Fax: 404-413-1140; E-mail:
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7
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van der Eijk Y. Standardised cigarettes: the next step for tobacco policy? Tob Control 2022:tobaccocontrol-2022-057417. [PMID: 35768214 DOI: 10.1136/tc-2022-057417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
As tobacco marketing restrictions intensify, tobacco companies increasingly turn to the cigarette product itself as a marketing medium with new flavours, capsules, novelty filter features and attractive cigarette stick designs. This paper considers a 'standardised cigarettes' policy as a potential next step in restricting tobacco marketing. This policy would remove from cigarette products all the elements that increase their appeal and addictiveness: added flavours, nicotine, and visual designs and branding. The result would be a cigarette that is flavourless, not especially addicting, and visually off-putting. This paper discusses what a standardised cigarettes policy might look like from a regulatory standpoint, and how it fits into current policy obligations under the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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8
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White CM, Watson C, Bravo Cardenas R, Ngac P, Valentin-Blasini L, Blount BC, Koopmeiners JS, Denlinger-Apte RL, Pacek LR, Benowitz NL, Hatsukami DK, Donny EC, Carpenter MJ, Smith TT. Early Changes in Puffing Intensity When Exclusively Using Open-Label Very Low Nicotine Content Cigarettes. Nicotine Tob Res 2022; 24:1798-1802. [PMID: 35524988 PMCID: PMC9597006 DOI: 10.1093/ntr/ntac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In response to reducing cigarette nicotine content, people who smoke could attempt to compensate by using more cigarettes or by puffing on individual cigarettes with greater intensity. Such behaviors may be especially likely under conditions where normal nicotine content (NNC) cigarettes are not readily accessible. The current within-subject, residential study investigated whether puffing intensity increased with very low nicotine content (VLNC) cigarette use, relative to NNC cigarette use, when no other nicotine products were available. METHODS Sixteen adults who smoke daily completed two 4-night hotel stays in Charleston, South Carolina (U.S.) in 2018 during which only NNC or only VLNC cigarettes were accessible. We collected the filters from all smoked cigarettes and measured the deposited solanesol to estimate mouth-level nicotine delivery per cigarette. These estimates were averaged within and across participants, per each 24-hour period. We then compared the ratio of participant-smoked VLNC and NNC cigarette mouth-level nicotine to the ratio yielded by cigarette smoking machines (when puffing intensity is constant). RESULTS Average mouth-level nicotine estimates from cigarettes smoked during the hotel stays indicate participants puffed VLNC cigarettes with greater intensity than NNC cigarettes in each respective 24-hour period. However, this effect diminished over time (p<0.001). Specifically, VLNC puffing intensity was 40.0% (95% CI: 29.9, 53.0) greater than NNC puffing intensity in the first period, and 16.1% (95% CI: 6.9, 26.0) greater in the fourth period. CONCLUSION Average puffing intensity per cigarette was elevated with exclusive VLNC cigarette use, but the extent of this effect declined across four days. IMPLICATIONS In an environment where no other sources of nicotine are available, people who smoke daily may initially attempt to compensate for cigarette nicotine reduction by puffing on individual cigarettes with greater intensity. Ultimately, the compensatory behavior changes required to achieve usual nicotine intake from VLNC cigarettes are drastic and unrealistic. Accordingly, people are unlikely to sustain attempts to compensate for very low cigarette nicotine content.
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Affiliation(s)
- Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Clifford Watson
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Roberto Bravo Cardenas
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Phuong Ngac
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Liza Valentin-Blasini
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Benjamin C Blount
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | | | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Anxiety, Depression, Psychological Symptoms, Negative Effects, and Other Symptoms of Nicotine Withdrawal. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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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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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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12
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Levy DT, Cummings KM, Heckman BW, Li Y, Yuan Z, Smith TT, Meza R. The Public Health Gains Had Cigarette Companies Chosen to Sell Very Low Nicotine Cigarettes. Nicotine Tob Res 2021; 23:438-446. [PMID: 32710538 DOI: 10.1093/ntr/ntaa128] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/01/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The U.S. Food and Drug Administration (FDA) has proposed lowering the nicotine content of cigarettes to a minimally addictive level to increase smoking cessation and reduce initiation. This study has two aims: (1) to determine when cigarette manufacturers had the technical capability to reduce cigarette nicotine content and (2) to estimate the lost public health benefits of implementing a standard in 1965, 1975, or 1985. METHODS To determine the technical capability of cigarette companies, we reviewed public patents and internal cigarette company business records using the Truth Tobacco Industry Documents. To evaluate the impact of a very low nicotine content cigarette (VLNC) standard on smoking attributable deaths (SADs) and life-years lost (LYLs), we applied a validated (CISNET) model that uses past smoking data, along with estimates of the potential impact of VLNCs derived from expert elicitation. RESULTS Cigarette manufacturers recognized that cigarettes were deadly and addictive before 1964. Manufacturers have had the technical capability to lower cigarette nicotine content for decades. Our model projected that a standard implemented in 1965 could have averted 21 million SADs (54% reduction) and 272 million LYLs (64% reduction) from 1965 to 2064, a standard implemented in 1975 could have averted 18.9 million SADs and 245.4 million LYLs from 1975 to 2074, and a standard implemented in 1985 could have averted 16.3 million SADs and 211.5 million LYLs from 1985 to 2084. CONCLUSIONS Millions of premature deaths could have been averted if companies had only sold VLNCs decades ago. FDA should act immediately to implement a VLNC standard. IMPLICATIONS Prior research has shown that a mandated reduction in the nicotine content of cigarettes could reduce the prevalence of smoking and improve public health. Here we report that cigarette manufacturers have had the ability to voluntarily implement such a standard for decades. We use a well-validated model to demonstrate that millions of smoking attributable deaths and life-years lost would have been averted if the industry had implemented such a standard.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Charleston, SC
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Charleston, SC
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, Cancer Epidemiology and Prevention Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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13
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Assessing Neutralized Nicotine Distribution Using Mice Vaccinated with the Mucosal Conjugate Nicotine Vaccine. Vaccines (Basel) 2021; 9:vaccines9020118. [PMID: 33546163 PMCID: PMC7913222 DOI: 10.3390/vaccines9020118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
Tobacco smoking continues to be a global epidemic and the leading preventable cause of cancer and cardiovascular disease. Nicotine vaccines have been investigated as an alternative to currently available smoking cessation strategies as a means to increase rates of success and long-term abstinence. Recently, we demonstrated that a mucosal nicotine vaccine was able to induce robust mucosal and systemic antibodies when delivered heterologously using intranasal and intramuscular routes. Herein, we investigated the neutralization ability of the anti-nicotine antibodies using both intranasal and intracardiac nicotine challenges. Combining the extraction of lyophilized organ samples with RP-HPLC methods, we were able to recover between 47% and 56% of the nicotine administered from the blood, brain, heart, and lungs up to 10 min after challenge, suggesting that the interaction of the antibodies with nicotine forms a stable complex independently of the route of vaccination or challenge. Although both challenge routes can be used for assessing systemic antibodies, only the intranasal administration of nicotine, which is more physiologically similar to the inhalation of nicotine, permitted the crucial interaction of nicotine with the mucosal antibodies generated using the heterologous vaccination route. Notably, these results were obtained 6 months after the final vaccination, demonstrating stable mucosal and systemic antibody responses.
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14
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Stanton CA, Hatsukami DK. Nicotine Standards in the United States. Nicotine Tob Res 2020; 21:S1-S4. [PMID: 31867658 PMCID: PMC6939765 DOI: 10.1093/ntr/ntz191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 01/20/2023]
Abstract
This Special Issue on nicotine standards in the United States will address many of the questions raised in the Advance Notice of Proposed Rulemaking (ANPRM) through a series of policy commentaries and timely empirical studies across a variety of topic areas within the proposed comprehensive nicotine standards plan. The questions addressed in this issue include: (1) the threshold dose of nicotine (and other constituents) that would lead to minimally addictive cigarettes; (2) the effects of a nicotine product standard in smokers with co-morbidity, youth and young adult smokers, and menthol smokers; (3) a step-down or targeted data approach to reducing nicotine in cigarettes; (4) perceptions and communications about product standards; and (5) requirements associated with the implementation of a nicotine product standard.
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Affiliation(s)
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN.,Department of Psychiatry, University of Minnesota, Minneapolis, MN
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