Evaluating oral noncombustible potential-reduced exposure products for smokers

Blank, Melissa D.; Eissenberg, Thomas

doi:10.1093/ntr/ntq003

Cited by 25 publications

(40 citation statements)

References 27 publications

(29 reference statements)

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“…Following this same logic, and taking into account the trace levels of tobacco specific nitrosamines found in some EC products (13), ECs may also warrant careful empirical examination by those interested in harm reduction for smokers. Clinical laboratory methods have an important role to play in this empirical examination, and can reveal carcinogen exposure and abstinence symptoms suppression over several days’ PREP use (e.g., 22, 26, 38, 40). These methods will likely be extremely important to any future regulation of ECs either as tobacco products or drug delivery devices in the U.S.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects

Vansickel

Cobb

Weaver

et al. 2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

346

354

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Background: Electronic "cigarettes" are marketed to tobacco users as potential reduced exposure products (PREP), albeit with little information regarding electronic cigarette user toxicant exposure and effects. This information may be obtained by adapting clinical laboratory methods used to evaluate other PREPs for smokers.Methods: Thirty-two smokers participated in four independent Latin-square ordered conditions that differed by product: own brand cigarette, "NPRO" electronic cigarettes (NPRO EC; 18 mg cartridge), "Hydro" electronic cigarettes (Hydro EC; 16 mg cartridge), or sham (unlit cigarette). Participants took 10 puffs at two separate times during each session. Plasma nicotine and carbon monoxide (CO) concentration, heart rate, and subjective effects were assessed.Results: Own brand significantly increased plasma nicotine and CO concentration and heart rate within the first five minutes of administration whereas NPRO EC, Hydro EC, and sham smoking did not. Own brand, NPRO EC, and Hydro EC (but not sham) significantly decreased tobacco abstinence symptom ratings and increased product acceptability ratings. The magnitude of symptom suppression and increased acceptability was greater for own brand than for NPRO EC and Hydro EC.Conclusions: Under these acute testing conditions, neither of the electronic cigarettes exposed users to measurable levels of nicotine or CO, although both suppressed nicotine/tobacco abstinence symptom ratings.Impact: This study illustrates how clinical laboratory methods can be used to understand the acute effects of these and other PREPs for tobacco users. The results and methods reported here will likely be relevant to the evaluation and empirically based regulation of electronic cigarettes and similar products. Cancer Epidemiol

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Section: Discussionmentioning

confidence: 99%

A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects

Vansickel

Cobb

Weaver

et al. 2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

346

354

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“…Similarly, clinical laboratory-based studies have shown that a single episode of tobacco smoking using a waterpipe delivers significantly higher levels of CO than the smoking of a single cigarette 23,24 , as well as that smokers’ use of some smokeless tobacco products reduces exposure to toxicants such as CO and the tobacco specific nitrosamine NNK 25 but fails to suppress withdrawal adequately. 26 Such findings from the clinical laboratory have direct implications for increasing understanding of the individual and public health burden of tobacco product use.…”

Section: Introductionmentioning

confidence: 99%

“…Short-term (eg, <12 hours) nicotine/tobacco abstinence is often used to assess product-related nicotine delivery and/or abstinence symptom suppression (eg, 47–50 ). Longer-term abstinence (eg, days or weeks) may be required as a negative control condition in studies designed to examine user toxicant exposure (eg, 14,26 ), the effects of nicotine after more than 12 hours abstinence (eg, 51,52 ), or product cessation outcomes (eg, 53,54 ). Common measures of product abstinence include self-report and biochemical markers of exposure such as expired air carbon monoxide (CO) or nicotine or cotinine in body fluids.…”

Section: Introductionmentioning

confidence: 99%

“…70 Thus, it offers a better index of long -term product abstinence than nicotine or CO. For example, urine cotinine concentration has been used to confirm nicotine abstinence over days (eg, 14,26 ) and weeks (eg, 71,72 ), and is recommended for use in the biochemical verification of tobacco abstinence in cessation studies. 54 Importantly, cotinine can be measured in urine semi -quantitatively or quantitatively.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Laboratory Evaluation of Electronic Cigarettes: Methodological Challenges

et al. 2016

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Objective Evaluating electronic cigarettes (ECIGs) in the clinical laboratory is critical to understanding their effects. However, laboratory evaluation of ECIGs can be challenging, as they are a novel, varied, and evolving class of products. The objective of this paper is to describe some methodological challenges to the clinical laboratory evaluation of ECIGs. Methods The authors gathered information about challenges involved in the laboratory evaluation of ECIGs. Challenges were categorized and solutions provided when possible. Results Methods used to study combustible cigarettes may need to be adapted to account for ECIG novelty and differences within the class. Challenges to ECIG evaluation can include issues related to 1) identification of ECIG devices and liquids, 2) determination of short -term ECIG abstinence, 3) measurement of use behavior, and 4) assessment of dependence. These challenges are discussed, and some suggestions to inform ECIG evaluation using clinical laboratory methods are provided. Conclusions Awareness of challenges and developing, validating, and reporting methods used to address them aids interpretation of results and replication efforts, thus enhancing the rigor of science used to protect public health through appropriate, empirically-based, ECIG regulation.

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“…Consequently, there likely exist aspects of the product, the consumer, and/or the environment that limit snus uptake in this population. The results of surveys, focus groups, and lab studies point toward dislike of the taste, oral sensation, and packaging of snus (Bahreinifar et al, 2013; Biener et al, 2016), in addition to dissatisfaction with nicotine delivery and suppression of withdrawal/craving (Blank & Eissenberg, 2010; Hatsukami et al, 2015), as reasons for smokers’ discontinuation of snus use. Additionally, some smokers’ perception of themselves as a “smoker” and not a “snuser” or “dual user” may reduce the likelihood of regular snus use (Bahreinifar et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

A longitudinal, naturalistic study of U.S. smokers' trial and adoption of snus

Burris

Wahlquist

Alberg

et al. 2016

Addictive Behaviors

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To refine public health policy amidst a changing landscape of tobacco products in the United States, it is first necessary to describe fully the nature of smokers’ alternative product use. Little research addresses smokers’ snus use, and most studies are limited by small samples, cross-sectional designs, and crude outcome measurement. This study sample includes 626 adult US smokers who denied intention to quit in the next month and were randomized to receive free snus during a 6-week sampling period, after which no snus was provided. Participants were then followed for one year. Outcome data were collected via phone. Participants (mean age: 48.7 years) were predominately female, White non-Hispanic. Eighty-four percent reported trial of snus. Eleven percent reported purchase (i.e., adoption). Current use declined from 47.1% at the end of the sampling period to 6.5% at the end of follow-up. Frequency and quantity of snus use among current users was low. Among snus users, 79.3% said it functioned as an alternative to smoking and 58.4% said it provided a means of coping with smoking restrictions; options not mutually exclusive. In logistic regressions, men were more likely to report trial (odds ratio [OR]=2.33, p < .01) and adoption (OR=1.84, p < .05) than women. Baseline expectations about the nature of snus use also predicted snus outcomes (OR=1.28–1.78, p < .05). Smokers showed willingness to try snus, but product interest waned over time. Snus as currently marketed is unlikely to play a prominent role in US tobacco control efforts.

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Evaluating oral noncombustible potential-reduced exposure products for smokers

Cited by 25 publications

References 27 publications

A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects

A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects

Clinical Laboratory Evaluation of Electronic Cigarettes: Methodological Challenges

A longitudinal, naturalistic study of U.S. smokers' trial and adoption of snus

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