Journal
PREVENTIVE MEDICINE
Volume 165, Issue -, Pages -Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ypmed.2022.107213
Keywords
Cigarette nicotine reduction; Very low nicotine content cigarettes; E-cigarettes; Electronic nicotine delivery systems; Alternative nicotine delivery systems; Tobacco regulatory science
Funding
- National Institute on Drug Abuse
- U.S. Food and Drug Administration (FDA) Center for Tobacco Products [U54DA031659]
- National Institutes of Health (NIH) [P30 CA77598]
- National Center for Advancing Translational Sciences of the National Institutes of Health [UL1TR0002494]
- NIDA [U54DA036105, R36DA054481]
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This study suggests that the reinforcing characteristics of e-cigarettes can moderate the impact of reducing cigarette nicotine content. The reduction in cigarette nicotine content has a larger effect when combined with moderate nicotine e-liquid and all flavors of e-liquid, rather than low nicotine e-liquid and tobacco flavors.
The reinforcing characteristics of e-cigarettes could moderate the impact of reducing cigarette nicotine content. In this study, people who smoke daily were recruited from North Carolina and Pennsylvania (US) in 2018 and 2019. Within a randomized 2 x 2 x 2 factorial design, participants received investigational cigarettes and an ecigarette for 12 weeks. Cigarette nicotine content was very low (0.4 mg/g of tobacco; VLNC) or normal (15.8 mg/ g; NNC). E-liquids were 0.3% (low) or 1.8% (moderate) freebase nicotine, and available in tobacco flavors or tobacco, fruit, dessert and mint flavors. Study recruitment concluded before reaching the planned sample size (N = 480). Fifty participants were randomized and 32 completed the study. We found that randomization to VLNC, relative to NNC cigarettes, reduced self-reported cigarettes per day (CPD; mean difference: -12.96; 95% CI: 21.51, 4.41; p = 0.005); whereas e-liquid nicotine content and flavor availability did not have significant effects. The effect of cigarette nicotine content was larger in the moderate vs. low nicotine e-liquid groups and in the all flavors versus tobacco flavors e-liquid groups; tests of the interaction between e-liquid characteristics and cigarette nicotine content were not significant. Biomarkers of smoke exposure at Week 12 did not differ across conditions, which may reflect variability in adherence to only using VLNC cigarettes. In conclusion this study offers preliminary evidence that the extent to which cigarette nicotine reduction decreases smoking may depend on the reinforcing characteristics of alternative products, including the available nicotine contents and flavors of e-cigarettes.
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