The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial

Smith, Tracy T.; Koopmeiners, Joseph S.; White, Cassidy M.; Denlinger-Apte, Rachel L.; Pacek, Lauren R.; Jesús, Víctor R. De; Wang, Lanqing; Watson, Clifford H.; Blount, Benjamin C.; Hatsukami, Dorothy K.; Benowitz, Neal L.; Donny, Eric C.; Carpenter, Matthew J.

doi:10.1158/1055-9965.epi-19-0963

Cited by 21 publications

(23 citation statements)

References 29 publications

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“…For example, one study found that smoking declined by approximately five cigarettes per day with an accompanying decrease in carbon monoxide when non-treatment seeking participants used low nicotine cigarettes while residing on an inpatient unit for 11 days ( Donny et al., 2007 ). In another recent residential study, Smith et al. (2020) aimed to more accurately capture the effects of a real-world nicotine reduction scenario.…”

Section: Resultsmentioning

confidence: 99%

A review of the evidence on cigarettes with reduced addictiveness potential

Donny

White

2022

International Journal of Drug Policy

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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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Section: Resultsmentioning

confidence: 99%

A review of the evidence on cigarettes with reduced addictiveness potential

Donny

White

2022

International Journal of Drug Policy

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“…Indeed, results from clinical trials consistently report reductions in smoking behavior, toxicant exposure, and nicotine dependence among adult smokers who switched to low nicotine content (LNC) cigarettes [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Such trials also report minimal evidence of the following potential unintended consequences: compensatory smoking behavior due to decreased nicotine levels, exacerbation of psychiatric symptoms, or increases in alcohol or cannabis use among adults smoking LNC cigarettes [ 12 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. In a simulation study, population estimates indicate that as many as 5 million people will quit smoking within the first year of a low nicotine product standard [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

Denlinger-Apte

Pacek

Ross

et al. 2021

IJERPH

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Background: As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. Methods: Data are from Wave 4 (2016–2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents’ absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. Results: The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were ‘about the same’ level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be ‘about the same’ harmfulness as medicinal nicotine. Conclusions: Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity.

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“…This can be done on a per-cigarette basis or a daily-dose basis by summing results from all butts collected over a 24 h period. We have successfully used our solanesol-based approach to examine difference in deliveries and smoking behavior as a function of menthol [ 32 ], tobacco blends [ 29 , 31 ], and the use of reduced-nicotine-content cigarettes [ 34 , 35 ] for a variety of mainstream smoke constituents. However, the scanner-based method could produce comparable data while saving time and money.…”

Section: Resultsmentioning

confidence: 99%

“…Such information provides data related to smoke constituent deliveries as well as behavioral use patterns. Our laboratory successfully used this method to examine the difference in deliveries of nicotine and tobacco-specific nitrosamines [ 31 ], the influence of menthol on smoking behavior [ 32 ], differences in smoking behaviors in a clinical setting [ 33 ], and changes in smoking when cigarette nicotine content is reduced [ 34 , 35 ]. This new luminosity-based, digital-image approach is a low-cost, high-throughput method that provides comparable results to our established liquid chromatography/tandem mass spectrometry (LC/MS/MS) solanesol method [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

A Low-Cost, High-Throughput Digital Image Analysis of Stain Patterns on Smoked Cigarette Filter Butts to Estimate Mainstream Smoke Exposure

Watson

Yan

Stanfill

et al. 2021

IJERPH

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Standard machine smoking protocols provide useful information for examining the impact of design parameters, such as filter ventilation, on mainstream smoke delivery. Unfortunately, their results do not accurately reflect human smoke exposure. Clinical research and topography devices in human studies yield insights into how products are used, but a clinical setting or smoking a cigarette attached to such a device may alter smoking behavior. To better understand smokers’ use of filtered cigarette products in a more natural environment, we developed a low-cost, high-throughput approach to estimate mainstream cigarette smoke exposure on a per-cigarette basis. This approach uses an inexpensive flatbed scanner to scan smoked cigarette filter butts and custom software to analyze tar-staining patterns. Total luminosity, or optical staining density, of the scanned images provides quantitative information proportional to mainstream smoke-constituent deliveries on a cigarette-by-cigarette basis. Duplicate sample analysis using this new approach and our laboratory’s gold-standard liquid chromatography/tandem mass spectrometry (LC/MS/MS) solanesol method yielded comparable results (+7% bias) from the analysis of 20 commercial cigarettes brands (menthol and nonmentholated). The brands varied in design parameters such as length, filter ventilation, and diameter. Plots correlating the luminosity to mainstream smoked-nicotine deliveries on a per-cigarette basis for these cigarette brands were linear (average R2 > 0.91 for nicotine and R2 > 0.83 for the tobacco-specific nitrosamine NNK), on a per-brand basis, with linearity ranging from 0.15 to 3.00 mg nicotine/cigarette. Analysis of spent cigarette filters allows exposures to be characterized on a per-cigarette basis or a “daily dose” via summing across results from all filter butts collected over a 24 h period. This scanner method has a 100-fold lower initial capital cost for equipment than the LC/MS/MS solanesol method and provides high-throughput results (~200 samples per day). Thus, this new method is useful for characterizing exposure related to filtered tobacco-product use.

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The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial

Cited by 21 publications

References 29 publications

A review of the evidence on cigarettes with reduced addictiveness potential

A review of the evidence on cigarettes with reduced addictiveness potential

Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations

A Low-Cost, High-Throughput Digital Image Analysis of Stain Patterns on Smoked Cigarette Filter Butts to Estimate Mainstream Smoke Exposure

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