Reduced Nicotine Content Expectancies Affect Initial Responses to Smoking

Abstract

Objectives We sought to determine if negative responses to reduced nicotine content (RNC) cigarettes during open-label trials result from smokers’ (negative) expectancies. We examined the effects of nicotine content description – independent of actual nicotine content – on subjective responses (craving reduction, withdrawal suppression, mood changes, and sensory ratings) and smoking behaviors (topography measures and carbon monoxide [CO] boost). Methods Thirty-six 12-hour-abstinent daily smokers completed a 3-session crossover trial. During each session, participants smoked their preferred brand cigarette – blinded and described as containing “usual,” “low,” and “very low” nicotine content – through a topography device and completed CO and subjective response assessments. Results Although nicotine content was identical, compared to the “usual” content cigarette, participants experienced less craving reduction after smoking the “very low” nicotine cigarette, and rated its smoke as weaker (p < .05). Participants took shallower puffs of the “low” nicotine cigarette (p < .05), and rated the “low” and “very low” nicotine cigarettes as weaker and too mild (p < .01). Conclusions Negative responses to RNC cigarettes may be due, in part, to negative expectancies about using cigarettes containing less nicotine. In this context, RNC cigarette marketing and labeling are likely important considerations if a federal nicotine reduction policy is initiated.

Attrition during a randomized controlled trial of reduced nicotine content cigarettes as a proxy for understanding acceptability of nicotine product standards

“…Participants’ expectancies about RNC cigarettes may have influenced attrition [29], although expectancies would likely similarly influence acceptability under federal nicotine regulation. Like most RNC cigarette trials, this study did not replicate the exact environment of mandated nicotine reduction; for example, because use periods were 10 days only, findings may not generalize to longer exposure (i.e., less willingness to use RNC cigarettes for a 6-week vs. 35-day trial may increase attrition).…”

“…Additionally, our sample of heavy-smoking, mainly white, non-menthol smokers from a single city may not represent the larger smoking population. Participants' expectancies about RNC cigarettes may have influenced attrition [29], although expectancies would probably influence acceptability similarly under federal nicotine regulation. Like most RNC cigarette trials, this study did not replicate the exact environment of mandated nicotine reduction; for example, because use periods were 10 days only, findings may not generalize to longer exposure (i.e.…”

Method for estimating non-study cigarette use among switchers to low nicotine content cigarettes in ambulatory clinical studies

“…To investigate whether under-reporting non-study cigarette use is common in different VLN cigarette switching studies, we applied this method to data from one study using cigarettes manufactured by Philip Morris USA [22] and two studies using cigarettes from the Vector Group [9,23]. Figure 4 presents the resulting average non-study CPD estimates and shows that there was under-reporting of non-study cigarette CPD across all three studies, although at lower magnitude than in Donny et al [2].…”

Low nicotine content descriptors reduce perceived health risks and positive cigarette ratings in participants using very low nicotine content cigarettes

“…For example, nicotine content expectancies significantly influence craving reduction, mood, wakefulness, calmness, concentration, satisfaction from smoking, and hunger reduction. [19][20][21][22][23] Other studies have found significant influences of nicotine content expectancies for other nicotine delivery products such as sprays and inhalers on satisfaction and craving relief. [24][25][26] These studies suggest the amount of nicotine that smokers believe is in a product can supersede their experience of receiving a different nicotine amount even at relatively high doses.…”