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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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2
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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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3
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Donny EC, White CM. A review of the evidence on cigarettes with reduced addictiveness potential. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103436. [PMID: 34535366 PMCID: PMC8785120 DOI: 10.1016/j.drugpo.2021.103436] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022]
Abstract
Background In May 2018, the Secretariat for the World Health Organization Framework Convention on Tobacco Control convened a meeting to discuss the potential for reducing the addictiveness of tobacco products. A central focus was to review research findings on the behavioral effects of reducing the addictiveness of cigarettes. Methods This manuscript reports the results of a review of the behavioral science literature, updated through April 2021, with special attention to both the potential benefits and unintended consequences of reducing nicotine in cigarettes. Results Available evidence suggests that reducing nicotine content in cigarettes to very low levels could benefit public health in three primary ways, by 1) decreasing uptake of regular smoking, 2) decreasing the amount people smoke, and 3) increasing the likelihood of smoking cessation. Current evidence also suggests that reducing nicotine in cigarettes may produce similar benefits across many important subpopulations of people who smoke, including those with psychiatric comorbidities, those who use other substances, those with low socioeconomic status, young people, people who smoke infrequently and people who prefer menthol cigarettes. Cigarette nicotine reduction could also lead to some undesirable outcomes, such as experiencing withdrawal, product manipulation, an illicit market, and harm misperceptions; strategies that may mitigate each are discussed. Conclusion Overall, behavioral research suggests product standards that limit the nicotine content of combusted tobacco products could render cigarettes and similar products less addictive. The availability of legal, non-combusted products that effectively substitute for cigarettes and the dissemination of public health campaigns that clarify misperceptions about the relationship between nicotine, tobacco and disease may facilitate the extent to which a nicotine reduction policy reduces smoking.
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Affiliation(s)
- Eric C Donny
- Wake Forest University School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, NC, USA.
| | - Cassidy M White
- Wake Forest University School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, NC, USA
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Chellian R, Behnood-Rod A, Wilson R, Wilks I, Knight P, Febo M, Bruijnzeel AW. Exposure to smoke from high- but not low-nicotine cigarettes leads to signs of dependence in male rats and potentiates the effects of nicotine in female rats. Pharmacol Biochem Behav 2020; 196:172998. [PMID: 32681850 DOI: 10.1016/j.pbb.2020.172998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023]
Abstract
Nicotine is only mildly rewarding, but after becoming dependent, it is difficult to quit smoking. The goal of these studies was to determine if low-nicotine cigarettes are less likely to cause dependence and enhance the reinforcing effects of nicotine than regular high-nicotine cigarettes. Male and female rats were exposed to tobacco smoke with a low or high nicotine level for 35 days. It was investigated if smoke exposure affects the development of dependence, anxiety- and depressive-like behavior, and nicotine-induced behavioral sensitization. Smoke exposure did not affect locomotor activity in a small open field or sucrose preference. Mecamylamine precipitated somatic withdrawal signs in male rats exposed to smoke with a high level of nicotine, but not in male rats exposed to smoke with a low level of nicotine or in females. After cessation of smoke exposure, there was a small decrease in sucrose preference in the male rats, which was not observed in the females. Cessation of smoke exposure did not affect anxiety-like behavior in the large open field or the elevated plus maze test. Female rats displayed less anxiety-like behavior in both these tests. Repeated treatment with nicotine increased locomotor activity, rearing, and stereotypies. Prior exposure to smoke with a high level of nicotine increased nicotine-induced rearing in the females. These findings indicate that exposure to smoke with a low level of nicotine does not lead to dependence and does not potentiate the effects of nicotine. Exposure to smoke with a high level of nicotine differently affects males and females.
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Affiliation(s)
| | - Azin Behnood-Rod
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
| | - Ryann Wilson
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
| | - Isaac Wilks
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
| | - Parker Knight
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
| | - Marcelo Febo
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL 32610, USA
| | - Adriaan W Bruijnzeel
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL 32610, USA.
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5
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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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6
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Piper ME, Drobes DJ, Walker N. Behavioral and Subjective Effects of Reducing Nicotine in Cigarettes: A Cessation Commentary. Nicotine Tob Res 2020; 21:S19-S21. [PMID: 31867644 PMCID: PMC6939774 DOI: 10.1093/ntr/ntz100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/14/2019] [Indexed: 12/27/2022]
Abstract
This commentary addresses critical questions regarding the impact of the reduction of nicotine on changes in smoking behavior. There appears to be moderate evidence that use of reduced nicotine cigarettes (RNC) increases the likelihood of making a quit attempt among smokers unmotivated to quit and among smokers motivated to quit who also used nicotine replacement therapy (NRT). There was limited evidence that RNC combined with NRT increased smoking abstinence, regardless of motivation to quit. Several plausible mechanisms via which RNC may influence smoking behavior, including reducing dependence, are reviewed. The moderate evidence that abrupt reduction in nicotine reduces self-reported dependence as well as smoking behavior and likelihood of relapse is also reviewed. The data reviewed here suggest that abrupt switching to, and extended use of, RNC can reduce cigarette dependence and several related constructs, including the ability to quit smoking. The data reviewed in this commentary suggest that abrupt reduction in the level of nicotine in combustible cigarettes could reduce smoking behavior, nicotine dependence, and other related constructs and increase quit attempts and eventual smoking cessation.
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Affiliation(s)
- Megan E Piper
- Department of Medicine, School of Medicine and Public Health, Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI
| | - David J Drobes
- Tobacco Research and Intervention Program, Moffitt Cancer Center, Tampa, FL.,Departments of Oncologic Sciences & Psychology, University of South Florida, Tampa
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, New Zealand
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Byron MJ, Hall MG, King JL, Ribisl KM, Brewer NT. Reducing Nicotine Without Misleading the Public: Descriptions of Cigarette Nicotine Level and Accuracy of Perceptions About Nicotine Content, Addictiveness, and Risk. Nicotine Tob Res 2019; 21:S101-S107. [PMID: 31867657 PMCID: PMC6939779 DOI: 10.1093/ntr/ntz161] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/05/2019] [Indexed: 01/14/2023]
Abstract
SIGNIFICANCE The public incorrectly believes very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes, a belief associated with lower motivation to quit under a VLNC standard. We examined how different descriptions of the nicotine level in VLNC cigarettes affect the accuracy of the public's perceptions about nicotine content, addictiveness, and cancer risk. METHODS Participants were a national convenience sample of 1353 US adults (22% smokers). In an online experiment, we randomized participants to a VLNC description using (1) concise language; (2) a percentage; (3) an interpretation; (4) a percentage and interpretation; (5) a percentage and a pictograph; or (6) a percentage, interpretation, and pictograph; or to a control description using (7) FDA's "minimally or nonaddictive" phrasing. We assessed accuracy of perceived nicotine content, addictiveness, and cancer risk compared to current cigarettes. RESULTS Compared to control, the percentage description resulted in more accurate perceptions about nicotine content (76% vs. 49% accuracy) and addictiveness (44% vs. 34%), but less accurate perceptions about cancer risk (56% vs. 68%; all ps < .05). Adding interpretation or pictographs to the percentage description did not increase accuracy. The concise language description reduced accuracy of perceived nicotine content and addictiveness but increased accuracy of cancer risk (all ps < .05). CONCLUSIONS Stating that 95% of nicotine would be removed more accurately conveyed the nicotine content and addictiveness of VLNC cigarettes. However, descriptions that better conveyed nicotine content and addictiveness misled people about cancer risk. IMPLICATIONS Implementation of a VLNC standard should include plans for a communication campaign that conveys that VLNC cigarettes will be less addictive but equally toxic to smoke. Stating the percent reduction in nicotine is likely to more clearly communicate reduced addictiveness but may also exacerbate risk misperceptions. VLNC communication requires further study to ensure the public accurately understands a VLNC standard.
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Affiliation(s)
- M Justin Byron
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jessica L King
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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8
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Heckman BW, Cummings KM, Nahas GJ, Willemsen MC, O’Connor RJ, Borland R, Hirsch AA, Bickel WK, Carpenter MJ. Behavioral Economic Purchase Tasks to Estimate Demand for Novel Nicotine/tobacco Products and Prospectively Predict Future Use: Evidence From The Netherlands. Nicotine Tob Res 2019; 21:784-791. [PMID: 29547973 PMCID: PMC6528146 DOI: 10.1093/ntr/nty042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The demand for alternative nicotine/tobacco products is not well established. This paper uses a behavioral economic approach to test whether smokers have differential demand for conventional factory-made, electronic, and very low nicotine content cigarettes (FMCs/ECs/VLNCs) and uses the prospective cohort design to test the predictive validity of demand indices on subsequent use of commercially available FMCs and ECs. METHODS Daily smokers (≥16 years) from the Netherlands completed an online survey in April 2014 (N = 1215). Purchase tasks were completed for FMCs, ECs, and VLNCs. Participants indicated the number of cigarettes they would consume in 24 h, across a range of prices (0-30 euro). The relationship between consumption and price was quantified into four indices of demand (intensity, Pmax, breakpoint, and essential value). A follow-up survey in July 2015 measured FMC and EC use. RESULTS At baseline, greater demand was observed for FMCs relative to ECs and VLNCs across all demand indices, with no difference between ECs and VLNCs. At follow-up, greater baseline FMC demand (intensity, essential value) was associated with lower quit rates and higher relapse. EC demand (Pmax, breakpoint, essential value) was positively associated with any EC use between survey waves, past 30 day EC use, and EC purchase between waves. CONCLUSIONS Smokers valued FMCs more than ECs or VLNCs, and FMCs were less sensitive to price increases. Demand indices predicted use of commercially available products over a 15 month period. To serve as viable substitutes for FMCs, ECs and VLNCs will need to be priced lower than FMCs. IMPLICATIONS Purchase tasks can be adapted for novel nicotine/tobacco products as a means to efficiently quantify demand and predict use. Among current daily smokers, the demand for ECs and VLNCs is lower than FMCs.
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Affiliation(s)
- Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Georges J Nahas
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, Netherlands
- Dutch Alliance for a Smokefree Society, The Hague, NL
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Alexander A Hirsch
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Warren K Bickel
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Byron MJ, Strasser AA, Delnevo CD. Little and filtered cigars meet the legal definition of cigarettes and should be included in nicotine reduction regulation. Tob Control 2018; 28:350-351. [PMID: 30021871 DOI: 10.1136/tobaccocontrol-2018-054410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
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Apelberg BJ, Feirman SP, Salazar E, Corey CG, Ambrose BK, Paredes A, Richman E, Verzi SJ, Vugrin ED, Brodsky NS, Rostron BL. Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States. N Engl J Med 2018. [PMID: 29543114 DOI: 10.1056/nejmsr1714617] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Benjamin J Apelberg
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Shari P Feirman
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Esther Salazar
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Catherine G Corey
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Bridget K Ambrose
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Antonio Paredes
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Elise Richman
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Stephen J Verzi
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Eric D Vugrin
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Nancy S Brodsky
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Brian L Rostron
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
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11
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Byron MJ, Jeong M, Abrams DB, Brewer NT. Public misperception that very low nicotine cigarettes are less carcinogenic. Tob Control 2018; 27:712-714. [PMID: 29363610 DOI: 10.1136/tobaccocontrol-2017-054124] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The USA is considering a very low nicotine content (VLNC) cigarette standard. We sought to characterise the prevalence and correlates of the incorrect belief that VLNC cigarettes are less carcinogenic than current cigarettes, as this could reduce motivation to quit. METHODS Participants were a nationally representative sample of 650 adult smokers in the USA. In 2015-2016, before the VLNC proposal became public, these smokers took part in an online survey. We used multivariate weighted analyses to calculate ORs and percentages and a χ2 test to examine the association between variables. RESULTS Overall, 47.1% of smokers believed that smoking VLNC cigarettes for 30 years would be less likely to cause cancer than smoking current cigarettes. This misperception was more common among smokers who were aged above 55 (56.6%) and black (57.4%). Additionally, 23.9% of smokers reported they would be less likely to quit if the USA adopted a VLNC standard. Thinking that VLNC cigarettes would be less carcinogenic was associated with smokers reporting they would be less likely to quit (P<0.01). CONCLUSIONS Many smokers had the misperception that smoking VLNC cigarettes is less likely to cause cancer, and some stated that they would be less likely to quit. A VLNC standard may be more effective if accompanied by a communication campaign that emphasises the continued dangers of smoking VLNC cigarettes due to the many toxic chemicals in smoke.
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Affiliation(s)
- M Justin Byron
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michelle Jeong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David B Abrams
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City, New York, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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12
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Nardone N, Donny EC, Hatsukami DK, Koopmeiners JS, Murphy SE, Strasser AA, Tidey JW, Vandrey R, Benowitz NL. Estimations and predictors of non-compliance in switchers to reduced nicotine content cigarettes. Addiction 2016; 111:2208-2216. [PMID: 27367436 PMCID: PMC5203964 DOI: 10.1111/add.13519] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/15/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Clinical trials on the impact and safety of reduced nicotine content cigarettes (RNCs) are ongoing, and an important methodological concern is participant compliance with smoking only RNCs. Our aims were to measure non-compliance biochemically with urine cotinine (COT) and total nicotine equivalents (TNEs), compare with self-reported non-compliance and identify associated covariates. DESIGN Secondary analysis of a double-blind, parallel, randomized clinical trial. SETTING Research centers from the United States, enrolling participants from June 2013 to July 2014. PARTICIPANTS Volunteer sample of 242 participants (55% Caucasian), average age of 41.2 years, smoking at least five cigarettes per day (CPD). INTERVENTION Smoking very low nicotine cigarettes (VLNCs; 0.4 mg nicotine/g tobacco) for 6 weeks. MEASUREMENTS The primary outcome was biochemically verified non-compliance, measured as thresholds of COT/CPD and TNE/CPD ratios, considering changes in nicotine content from conventional levels to VLNCs, and as an absolute threshold of week 6 TNEs. Self-reported non-compliance was measured via daily phone calls. Key predictors included age, sex, race, menthol preference, nicotine metabolite ratio, time to first cigarette, dependence, CPD, TNEs, tar level and cigarette evaluation. FINDINGS Estimates of non-compliance with smoking the VLNCs exclusively include: the biochemical ratios (both 78%), the week 6 TNE threshold (76%) and self-report (39%). Of the key covariates, age, dependence and cigarette evaluations of satisfaction were significant; for age, younger participants more likely to be non-compliant [P = 0.01; odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.96-0.99]. Dependence was associated significantly with self-reported non-compliance (P = 0.01; OR = 1.28, 95% CI = 1.06-1.55). Cigarette evaluations of satisfaction were associated significantly with non-compliance (P = 0.001; OR = 0.71, 95% CI = 0.61-0.82). CONCLUSIONS Among smokers volunteering to smoke only very low nicotine cigarettes for 6 weeks, non-compliance was common and biochemical assessments detected more cases of non-compliance than self-report. Despite high levels of non-compliance, smokers reduced their intake of nicotine by an average of 60%.
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Affiliation(s)
- Natalie Nardone
- University of California, San Francisco, Department of Medicine, 3130 20th Street, Suite 308, San Francisco, CA 94110
| | - Eric C. Donny
- University of Pittsburgh, Department of Psychology, 210 S. Bouquet St, Pittsburgh, PA 15260
| | - Dorothy K. Hatsukami
- University of Minnesota, Department of Psychiatry, 717 Delaware St SE, Minneapolis, MN 55414
| | - Joseph S. Koopmeiners
- University of Minnesota, School of Public Health, 420 Delaware St. SE, Minneapolis, MN 55455
| | - Sharon E. Murphy
- University of Minnesota, Department of Biochemistry, Molecular Biology, & Biophysics, 2231 6th St SE, Minneapolis, MN 55455
| | - Andrew A. Strasser
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA 19104
| | - Jennifer W. Tidey
- Brown University, Department of Psychiatry & Human Behavior, Box G-S121-5, 121 South Main Street, Providence, RI 02903
| | - Ryan Vandrey
- Johns Hopkins University, Department of Psychiatry & Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - Neal L. Benowitz
- University of California, San Francisco, Department of Medicine and Bioengineering & Therapeutic Sciences, Box 1220, San Francisco, CA 94143-1220
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Kozlowski LT. Commentary on Nardone et al. (2016): Satisfaction, dissatisfaction and complicating the nicotine-reduction strategy with more nicotine. Addiction 2016; 111:2217-2218. [PMID: 28075539 DOI: 10.1111/add.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/05/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
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14
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Donny EC, Walker N, Hatsukami D, Bullen C. Reducing the nicotine content of combusted tobacco products sold in New Zealand. Tob Control 2016; 26:e37-e42. [DOI: 10.1136/tobaccocontrol-2016-053186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 11/04/2022]
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Allen K, Kypridemos C, Hyseni L, Gilmore AB, Diggle P, Whitehead M, Capewell S, O'Flaherty M. The effects of maximising the UK's tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study. BMC Public Health 2016; 16:292. [PMID: 27036296 PMCID: PMC4818400 DOI: 10.1186/s12889-016-2962-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Smoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities. The United Kingdom (UK) has comprehensive smoking policies in place: regular tax increases; public information campaigns; on-pack pictorial health warnings; advertising bans; cessation; and smoke-free areas. This is confirmed from its high Tobacco Control Scale (TCS) score, an expert-developed instrument for assessing the strength of tobacco control policies. However, room remains for improvement in tobacco control policies. Our aim was to evaluate the cumulative effect on smoking prevalence of improving all TCS components in England, stratified by socioeconomic circumstance. Methods Effect sizes and socioeconomic gradients for all six types of smoking policy in the UK setting were adapted from systematic reviews, or if not available, from primary studies. We used the IMPACT Policy Model to link predicted changes in smoking prevalence to changes in premature coronary heart disease (CHD) mortality for ages 35–74. Health outcomes with a time horizon of 2025 were stratified by quintiles of socioeconomic circumstance. Results The model estimated that improving all smoking policies to achieve a maximum score on the TCS might reduce smoking prevalence in England by 3 % (95 % Confidence Interval (CI): 1–4 %), from 20 to 17 % in absolute terms, or by 15 % in relative terms (95 % CI: 7–21 %). The most deprived quintile would benefit more, with absolute reductions from 31 to 25 %, or a 6 % reduction (95 % CI: 2–7 %). There would be some 3300 (95 % CI: 2200–4700) fewer premature CHD deaths between 2015–2025, a 2 % (95 % CI: 1.4–2.9 %) reduction. The most disadvantaged quintile would benefit more, reducing absolute inequality of CHD mortality by about 4 % (95 % CI: 3–9 %). Conclusions Further, feasible improvements in tobacco control policy could substantially improve population health, and reduce health-related inequalities in England. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2962-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirk Allen
- Lancaster Medical School, Lancaster University, Lancaster, UK.,Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
| | - Peter Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
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McDaniel PA, Smith EA, Malone RE. The tobacco endgame: a qualitative review and synthesis. Tob Control 2015; 25:594-604. [PMID: 26320149 PMCID: PMC5036259 DOI: 10.1136/tobaccocontrol-2015-052356] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/04/2015] [Indexed: 11/13/2022]
Abstract
The tobacco endgame concept reorients discussion away from the persistent control of tobacco toward plans for ending the tobacco epidemic, and envisions a tobacco-free future. A variety of policy approaches have been proposed, with many offered prior to the introduction of the unifying term ‘endgame’. We conducted a qualitative synthesis of the literature on tobacco control endgames, and drew on media accounts and discussion of analogous ideas for illustrative purposes. We identified proposals focused on the product, user, market/supply or larger institutional structures. Research on public support for these proposals was limited, but suggestive of some public appetite for endgame ideas. Advocates should be encouraged to explore new policy options and consider the goal of a tobacco-free future.
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Affiliation(s)
- Patricia A McDaniel
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
| | - Elizabeth A Smith
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
| | - Ruth E Malone
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
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Wu L, Sun S, He Y, Zeng J. Effect of Smoking Reduction Therapy on Smoking Cessation for Smokers without an Intention to Quit: An Updated Systematic Review and Meta-Analysis of Randomized Controlled. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10235-53. [PMID: 26308034 PMCID: PMC4586609 DOI: 10.3390/ijerph120910235] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Effective strategies are needed to encourage smoking cessation for smokers without an intention to quit. We systematically reviewed the literature to investigate whether smoking reduction therapy can increase the long-term cessation rates of smokers without an intention to quit. METHODS PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) on the effect of smoking reduction therapy on long-term smoking cessation in smokers without an intention to quit. The primary outcome was the cessation rate at the longest follow-up period. A random effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Fourteen trials with a total of 7981 smokers were included. The pooled analysis suggested that reduction support plus medication significantly increased the long-term cessation of smokers without an intention to quit compared to reduction support plus placebo (RR, 1.97; 95% CI, 1.44-2.7; I(2), 52%) or no intervention (RR, 1.93; 95% CI, 1.41-2.64; I(2), 46%). In a subgroup of smokers who received varenicline or nicotine replacement therapy (NRT), the differences were also statistically significant. This suggests the safety of using NRT. The percentage of smokers with serious adverse events who discontinued because of these events in the non-NRT group was slightly significantly different than in the control group. Insufficient evidence is available to test the efficacy of reduction behavioural support in promoting long-term cessation among this population. CONCLUSIONS The present meta-analysis indicated the efficacy of NRT- and varenicline-assisted reduction to achieve complete cessation among smokers without an intention to quit. Further evidence is needed to assess the efficacy and safety of reduction behavioural support and bupropion.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Samio Sun
- Department of Bioengineering, The University of Tokyo, 1138656, Japan.
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
- State Key Laboratory of Kidney Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Jing Zeng
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
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