Nicotine Content Cigarettes Research Articles

International survey of young adults’ opinions on tobacco endgame measures & e-cigarette regulations

Abstract In the last decade, while tobacco consumption has decreased, there has been a significant rise in e-cigarette usage particularly among young people. Tobacco-free generations and other endgame strategies are being considered in several countries, moving from tobacco control towards ending the tobacco epidemic. This online survey of 18-34-year-olds evaluated opinions on potential endgame measures and e-cigarette regulations, to generate evidence to inform policy decisions. The survey was developed with input from the World Federation of Public Health Associations and Tobacco-Free Ireland, asking participants about support (yes/no) for 20 endgame measures in 4 domains and attitudes towards e-cigarettes. Utilising convenience sampling, the survey was distributed through international networks. Of 295 responses in 34 countries, 72% were never smokers and 56% were never e-cigarette users. 31% were aware of tobacco endgame. 68% supported increasing tobacco purchasing age to 21. 70% supported restricting tobacco sales to a limited number of licenced shops. 73% supported reducing nicotine content in cigarettes. 74% supported tobacco companies having to pay for health costs from smoking. 73% would like to see tobacco-free generation legislation in their country, but only 31% expected it would be successful. Regarding e-cigarettes, they were judged as more desirable than cigarettes mostly due to different flavours and visual appearance (both 74%). They were perceived to be an important health risk (82%) and as or more addictive than cigarettes (78%). 65% believed overall harms from e-cigarettes outweigh benefits for society. 86% felt they should be subjected to the same advertising restrictions as cigarettes and 66% supported increasing their cost. There was strong support for various tobacco endgame measures and tobacco-free generation legislation in this 18-34-year-old cohort. The majority recognised health risks of e-cigarettes and favoured stricter regulation of these products. Key messages • An international survey of 295 young adults in 34 countries demonstrated strong support for various tobacco endgame measures including tobacco-free generation legislation. • For e-cigarettes, there was wide acknowledgement of addictiveness and health risk, and support for increased education and warnings, lower nicotine content and reduced advertising and availability.

Effects of Very Low Nicotine Content Cigarettes and Nicotine Vaping Device Characteristics on Choices to Smoke, Vape, or Abstain in Early Young Adults.

A national nicotine reduction policy could reduce the public health toll of smoking. However, reducing nicotine in cigarettes may lead to changes in the use of other tobacco products such as nicotine vaping devices, particularly among young people. Product use outcomes may depend on characteristics of available nicotine vaping devices. We aimed to determine the impact of cigarette nicotine content, vaping device nicotine concentration, and vaping device flavors on choices to smoke, vape, or abstain. Early young adults (ages 18-20 inclusive, N=80) who reported smoking daily and vaping nicotine at least twice in their lifetime participated in a laboratory study. Participants received either Very Low Nicotine Content (VLNC; 0.4mg nicotine/g of tobacco) or Normal Nicotine Content (NNC; 15.8mg/g) cigarettes. First, participants chose between their assigned cigarette or abstaining. Subsequently, participants chose between 2 cigarette puffs, 2 vape puffs, or abstaining. Vaping device nicotine concentration (3mg vs. 18mg/ml) and flavor (tobacco vs. non-tobacco) were manipulated within-subjects. When only cigarettes were available, there were no differences between the VLNC and NNC groups on cigarette choices. When the nicotine vaping device was concurrently available, the VLNC group made fewer choices to smoke than the NNC group. Non-tobacco flavors and lower vaping device nicotine concentration were associated with fewer choices to smoke. Nicotine vaping device availability reduced choices to smoke VLNC cigarettes, and vaping devices with lower nicotine and non-tobacco flavors led to the fewest choices to smoke. Regulators should consider that the availability and characteristics of alternative tobacco products can moderate the product standard's impact. The U.S. Food and Drug Administration may enact a reduced nicotine product standard that would affect all commercially-available cigarettes. One important population affected by this policy would be early young adults who smoke. We aimed to determine the impact of cigarette nicotine content, vaping device nicotine concentration, and vaping device flavors on choices to smoke, vape, or abstain. Lower nicotine in cigarettes, along with non-tobacco flavors and lower nicotine concentration in the vaping device, were associated with the fewest choices to smoke. Regulators should consider that the availability and characteristics of alternative tobacco products can moderate the product standard's impact.

Perceptions of the Addictiveness of Low-Nicotine Cigarettes Versus Typical Cigarettes and Exposure to Tobacco Industry-Sponsored Corrective Campaign

Background In 2017, the U.S. Food and Drug Administration (FDA) announced a regulatory plan to reduce the nicotine content of cigarettes. This study examines the association of exposure to industry-sponsored corrective statements on perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes within the general US population. Methods The study comprised 4975 US adult respondents of the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3). Multinomial logistic regression models were used to examine associations between exposure to tobacco industry corrective messages and perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes. Results In the overall population, 4.1% reported that low-nicotine cigarettes were much more addictive than typical cigarettes, 67.5% said they were equally addictive, while 28.4% reported they were slightly/much less addictive. Adults exposed to industry-sponsored corrective messages had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR 1.57; 95% CI, 1.13–2.19) than those who saw no corrective messages. Those exposed to the corrective messages specifically about the addictiveness of smoking and nicotine had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR, 1.73; 95% CI, 1.07–2.81) compared to those who saw no corrective message. Conclusions Our findings suggest that exposure to court-ordered tobacco industry corrective statements may have reinforced perceptions on the addictive potential of nicotine. However, study findings indicate a need for campaigns specifically tailored to address misperceptions observed in this study.

Cigarette smoking and cognitive task performance: Experimental effects of very-low nicotine-content cigarettes.

Reductions in the nicotine content of cigarettes decrease smoking rate and dependence severity, but effects on cognition are less well established. The potential impacts of very-low nicotine-content (VLNC) cigarettes on cognitive task performance must be evaluated, especially in vulnerable populations. The aim of the present study is to experimentally examine the effects of VLNC cigarettes on cognitive performance. Adults who smoked daily (n = 775) from three vulnerable populations (socioeconomically disadvantaged reproductive-age women, individuals with opioid use disorder, affective disorders) were examined. Participants were randomly assigned to normal nicotine content (NNC; 15.8 mg nicotine/g tobacco) or VLNC (2.4 mg/g or 0.4 mg/g) cigarettes for 12 weeks. Response inhibition (stop-signal task), working memory (n-back task; n of 2-n of 0), and cognitive interference (nicotine Stroop task) were assessed at baseline, 2, 6, and 12 weeks. Results were analyzed using mixed-model repeated-measures analyses of variance. Extended exposure to VLNC cigarettes produced no significant changes in any measure of cognitive performance compared to NNC cigarettes. Over weeks, response times on the n-back task decreased across doses. No significant effects were observed on the stop-signal or nicotine Stroop tasks. All three vulnerable populations performed comparably on all three cognitive tasks. Extended exposure to VLNC cigarettes produced no impairments in cognitive performance on any of the assessed tasks compared to NNC cigarettes. These findings are consistent with the larger literature detailing other consequences following exposure to VLNC cigarettes and are encouraging for the adoption of a nicotine-reduction policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nicotinic Receptor Alpha-5 Subunit Gene Polymorphism is Associated With Heavy Smoking Under a Range of Nicotine Dosing Conditions.

This study aimed to assess the role of the rs16969968 variant of nicotinic receptor alpha-5 subunit in regulating smoking behavior and nicotine intake in response to nicotine manipulations among dependent smokers in a naturalistic environment. Sixty-nine adults (19 females) smoking 10 or more cigarettes per day (CPD) were asked to complete four 2-week study phases during which they smoked exclusively one of two types of Spectrum nicotine research cigarettes (FTC nicotine yield 0.8 and 1.6 mg, respectively), their usual brand of cigarettes, or their usual brand of cigarettes while wearing a 21-mg nicotine patch. Measurements included rs16969968 genotype, number of CPD, smoking topography, and plasma cotinine. Compared to controls (G/G carriers), A allele carriers reported smoking 4 to 5 more CPD across all conditions (all ps < .05). Mean total smoke volume per day and cotinine were greater in A allele carriers than in controls (ps = .05, .046, respectively). No significant genotype differences were found in smoking compensation indices for the switch from medium to high-nicotine-yield cigarettes. Nicotine patch-induced reductions in cigarettes smoked per day and total smoke volume per day showed significant interactions between genotype and pre-patch levels, with heavier smokers showing greater effects of genotype (p = .052 and p = .006, respectively). Results suggest that the rs16969968 variants regulate the heaviness of smoking primarily by their impact on daily numbers of cigarettes smoked, but no genotype differences were found in smoking compensation after switching from medium to high-nicotine cigarettes. The differences in daily cigarette consumption between rs16969968 risk-allele carriers and controls are shown to be consistent regardless of manipulations of cigarette nicotine content and transdermal nicotine supplementation and markedly greater among dependent smokers than those observed in the general smoker populations. G/G allele carriers, relative to A allele carriers, appeared to be more sensitive to the nicotine patch manipulation, reducing their smoking to a greater extent. These findings support continued efforts in the development of personalized intervention strategies to reduce the rs16969968-conveyed genetic propensity for heavy smoking.

Nicotine detection in tobacco samples via a molecularly imprinted polymers sensing platform

A highly sensitive and selective molecularly imprinted polymer (MIP) sensing platform was developed for the detection of nicotine in tobacco samples. The MIP sensor was fabricated by integrating a PtNPs/GO nanocomposite with an electropolymerized nicotine-imprinted film on a glassy carbon electrode. Under optimal conditions (pH 7.4, 50 mM pyrrole, and 30 min elution time), the MIP sensor exhibited a wide linear range (0.01–0.5 μM and 0.5–100 μM), low detection limit (0.015 μM), good reproducibility (RSD < 4.2 %), and long-term stability (93.2 % retention after 30 days). The MIP sensor demonstrated excellent selectivity towards nicotine, with selectivity coefficients ranging from 7.2 to 9.5 against interfering substances. The practical applicability of the MIP sensor was validated by analyzing nicotine content in cigarettes and chewing tobacco samples, with recoveries ranging from 97.5 % to 102.8 % and relative errors within ±5 % compared to the reference GC-MS method. The proposed MIP-based electrochemical sensing platform offers a rapid, simple, and cost-effective approach for sensitive and selective detection of nicotine in complex tobacco matrices, showing great potential for applications in the tobacco industry and public health sector.

Public support for tobacco endgame policies in South Korea: Findings from the 2020 International Tobacco Control Korea Survey

BackgroundStrong public support can increase the likelihood of adopting tobacco control policies. We assessed support for six commercial tobacco endgame policies in South Korea: limiting the nicotine in cigarettes, banning...

Reactions to Messages About a Nicotine Reduction Policy: A Focus Group Study Among People Who Use Little Cigars and Cigarillos.

The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. This qualitative study documents reactions to messages communicating this policy among people who use little cigars and cigarillos (LCCs). We conducted eight focus groups with participants from four populations with the highest prevalence of cigar use (African American males and females, white males and females). Participants described their reactions to eight messages about the policy: Three messages about the equal risk of LCCs with regular and low nicotine levels; three quit efficacy messages about low nicotine LCCs being easier to quit; one "compensation" message to correct misperceptions about the policy causing people to smoke more to get desired nicotine; and one message about using alternative nicotine sources (eg, e-cigarettes). Participants perceived risk messages as the most motivating to quit, whereas efficacy messages made some participants feel that the policy would cause former users of LCCs to relapse. Many participants expressed favorable responses to the compensation message. The message about using alternative nicotine sources sparked intense responses, with many participants expressing outrage and mistrust of the message. Participants' beliefs that they were not addicted to LCCs dampened their perceptions of the effectiveness of the policy. Perceptions of the addictiveness and relative harms of LCCS influenced responses to policy messages. The FDA should consider using different messages to communicate with people who use LCCs because they perceive LCCs as different from cigarettes. This is the first study to document affective and cognitive responses to the FDA's reduced nicotine policy among people who use LCCs. The false belief that cigar products are less harmful than cigarettes may be influencing people's lack of support for the reduced nicotine policy and difficulty in understanding its potential positive impact. To maximize the public health benefit of the reduced nicotine policy, the FDA should include LCC products in the policy; however, it is crucial that they use educational messaging to clarify misperceptions regarding nicotine and harm as it applies to LCCs.

A core-molecule-shell Au@PATP@Ag nanorod for nicotine detection based on surface-enhanced Raman scattering technology

Nicotine is an addictive substance often found in tobacco and cigarette smoke and excessive exposure to it can cause various diseases. Herein, core-molecule-shell gold/4-aminothiophenol/silver nanorods (Au@PATP@Ag NRs) were prepared for quantitative detection of nicotine by using surface-enhanced Raman scattering (SERS) technology. The obtained Au@PATP@Ag NRs showed an outstanding SERS effect due to the plasticity of their morphology and the bimetallic synergistic effect between the excellent stability of Au and the highly enhanced effect of Ag. The Au@PATP@Ag NRs substrate exhibited an extremely high enhancement factor (EF) of 2.17 × 107. In addition, in-situ synthesized PATP was used as an internal standard to correct signal fluctuation and improve the reliability of quantitative nicotine detection. A wide linear dynamic range from 10−8 to 10−3 M was obtained and an ultra-low limit of detection (LOD) was about 3.12 × 10−9 M, which was superior to most of previously reported methods. This work has also been used for determining nicotine content in cigarettes and simulated environmental tobacco smoke by using a portable device. These results indicated that the developed SERS method had many potential applications in the quantitative determination of nicotine in real tobacco samples.

"I Crave a Blunt, I Don't Crave a Cigarillo": A Focus Group Study on Perceptions of Nicotine and Addiction among US Adults Who Currently Smoke Little Cigars or Cigarillos.

While the US Food and Drug Administration (FDA)'s proposal to reduce the nicotine content in cigarettes is gaining traction, it is still undetermined whether the policy will also include other combustible tobacco products, such as little cigars and cigarillos (LCCs), and how such a policy should be communicated given the patterns of use and perceptions around LCCs. This study examined perceptions of nicotine and addiction related to LCC use and involved data collection from eight semi-structured virtual focus groups conducted in Summer 2021 in the US. Participants were adults who reported past-30-day use of LCCs, consisting of African American males (n = 9), African American females (n = 9), white males (n = 14), and white females (n = 11). Participants discussed their perceptions of nicotine and addiction in general and in relation to LCC use. Inductive thematic analysis of transcripts was conducted. Differences across race and sex groups were examined. Participants did not consider nicotine to be a characterizing feature of LCCs; rather, they generally associated nicotine with cigarettes. Participants' views of nicotine and addiction related to LCCs were discussed along four dimensions: context of use, frequency of use, the presence of cravings, and whether a product is modified (e.g., by adding marijuana). Social and infrequent use, a lack of cravings, and the use of LCCs for marijuana were considered indicative of a lack of addiction and reasons not to be concerned about nicotine in LCCs. Because perceptions of nicotine and addiction related to LCCs differ from those of cigarettes, communications about a reduced nicotine policy that includes LCCs should consider these differences to ensure the policy is understood by people who currently use LCCs and to prevent people who use cigarettes from switching to LCCs.

Electronic cigarettes with different nicotine concentrations in unflavoured liquid induce oxidative stress

Background/Aim: Nicotine content and flavour in electronic cigarette (e-cig) liquids have been demonstrated to cause oxidative stress in acute exposure. However, the chronic effects of using unflavoured and with or without nicotine in e-cigs liquid have not been evaluated. This in vivo study aims to investigate the chronic effect of e-cig exposure with unflavoured liquids at different nicotine concentrations on oxidative stress. Methods: The 24 male Wistar rats were divided into four groups of six each. Normal, as a control group. Nic 0, Nic 6 and Nic 12 groups were exposed to unflavoured e-cig liquid for eight weeks with different nicotine concentrations: 0, 6 and 12 mg/mL, respectively. E-cig exposure in rats was conducted using an exposure instrument adjusted to real-life exposure to humans. Oxidative stress markers, including plasma, liver and lung malondialdehyde (MDA) and superoxide dismutase (SOD), as well as plasma catalase (Cat) and glutathione peroxidase (GPx) were assessed at the end of the study. Results: Unflavoured e-cig liquids induced oxidative stress in a nicotine concentration-dependent manner, in which the nicotine content of 12 mg/mL demonstrated the greatest response. There was a significant increase in plasma, liver and lung MDA and concurrently decreased plasma and selected organs SOD, as well as plasma Cat and GPx in all nicotine concentration exposed groups compared to the Normal group. Conclusions: Chronic unflavoured liquids in e-cig exposure at different nicotine concentrations induced oxidative stress, potentially leading to various oxidative stress-induced diseases.

Determinants of Hardcore Smoking in a MULTI-ETHNIC Study of Cigarette Smokers in Singapore

ABSTRACT Smokers who are resistant to quitting are not well studied in Asia, particularly in multi-ethnic populations. We compared the characteristics of hardcore smokers in Singapore, a multi-ethnic Asian population, with other daily smokers, and investigated the role of ethnicity as an effect modifier on identified determinants, including cigarette flavor preferences, using cross-sectional data from Singapore Smokers’ Survey (n = 1,501). Multivariable logistic regression was used to assess the association. 22.8% of adult daily smokers were hardcore smokers. Novel findings on hardcore smokers’ preference for regular flavored cigarettes (AOR = 1.54; 95%CI: 1.14, 2.07) suggest there is room for interventions among hardcore smokers through regulation of cigarette flavors and nicotine content. Although ethnicity was not a significant factor, it was an effect modifier with peers’ disapproval of smoking (p-value for interaction = 0.024), significantly lowering odds of Malays being hardcore smokers (stratified odds ratio, AOR stratified, Malay = 0.35; CI: 0.17, 0.71), but not Chinese (AOR stratified, Chinese = 1.27; CI: 0.70, 2.42) and Indian smokers (AOR stratified, Indian = 0.62; CI: 0.18, 2.28), suggesting that smoking cessation policies utilizing social norm change strategies may be more effective when tailored to the differing roles of peer norms among different ethnic groups, in Singapore and other multi-ethnic Asian populations.

Impact of a reduced nicotine standard on young adult appeal for menthol and non-menthol cigarettes

IntroductionThe Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product...

Potential effects of nicotine content in cigarettes on use of other substances

A national nicotine reduction policy has the potential to reduce cigarette smoking and associated adverse health impacts among vulnerable populations. However, possible unanticipated adverse effects of reducing nicotine content in cigarettes, such as increasing the use of alcohol or other abused substances, must be examined. The purpose of this study was to evaluate the effects of exposure to varying doses of nicotine in cigarettes on use of other substances. This was a secondary analysis (n = 753) of three simultaneous, multisite, double-blind, randomized-controlled trials examining 12 weeks of exposure to study cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco) among daily smokers from three vulnerable populations: individuals with affective disorders (n = 251), individuals with opioid use disorder (n = 256), and socioeconomically-disadvantaged women of reproductive age (n = 246). Effect of study cigarette assignment on urine toxicology screens (performed weekly) and responses to drug and alcohol use questionnaires (completed at study weeks 6 and 12) were examined using negative binomial regression, logistic regression, or repeated measures analysis of variance, controlling for sex, age, and menthol status. The most common substances identified using urine toxicology included tetrahydrocannabinol (THC; 44.8%), cocaine (9.2%), benzodiazepine (8.6%), and amphetamines (8.0%), with 57.2% of participants testing positive at least once for substance use (27.3% if excluding THC). No significant main effects of nicotine dose were found on any of the examined outcomes. These results suggest that reducing nicotine content does not systematically increase use of other substances, even among individuals at increased risk of substance use.ClinicalTrials.gov Identifiers: NCT02232737, NCT2250664, NCT2250534.

Preliminary evidence on cigarette nicotine reduction with concurrent access to an e-cigarette: Manipulating cigarette nicotine content, e-liquid nicotine content, and e-liquid flavor availability

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 × 2 × 2 factorial design, participants received investigational cigarettes and an e-cigarette 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.

In Case You Haven't Heard…

Many years ago, then‐Surgeon General Everett Koop warned that nicotine is more addictive than heroin. That fateful day, in 1988, marked the beginning of what appeared to be a successful industry aimed at treating nicotine addiction. There were gums, patches, and more to help people stop smoking, which cost them a lot of money and possible future lung and other cancers. Now, we have vaping, including of nicotine, which at least is not combustible and, it is hoped, avoids the cancer problems. But it is still addictive. Ask any teenager, and you will learn that it's common in high school and college. Nicotine withdrawal is unpleasant. But there are still U.S. Food and Drug Administration (FDA)‐approved products to help. These are not vaping devices. With the FDA's current move to restrict the nicotine content of cigarettes, it's likely that there will be more demand for these products. For more information, go to https://www.fda.gov/consumers/consumer‐updates/want‐quit‐smoking‐fda‐approved‐and‐fda‐cleared‐cessation‐products‐can‐help.

Menthol preference moderates the relationship between cigarette nicotine content choice and reactions in young adults who smoke infrequently

BackgroundHalf of young adults who smoke use menthol cigarettes, which is associated with continued smoking and greater nicotine dependence. Additionally, early subjective reactions to cigarettes predict future use. Menthol may blunt the sensory effects of nicotine. We investigated the moderating role of menthol on subjective reactions to, and choice of varied nicotine content cigarettes in young adults who smoke infrequently. MethodsIn three counterbalanced, double-blinded sessions, young adults who smoke ≤ 15 days/month smoked fixed doses from very low (VLNC), intermediate (INC), and normal (NNC) nicotine content cigarettes, which were menthol or non-menthol depending on preference. Participants chose their preferred cigarette in a final session. Positive and negative subjective reactions were measured in each session. ANOVA tests investigated the relationship between menthol preference, nicotine content, and subjective reactions. ResultsParticipants (N = 87) were 18–25 years old and reported smoking 15.2 cigarettes per month over 8 days (35 % menthol). Non-menthol preferring participants had increased negative reactions with greater nicotine content (F(1, 55)= 10.76, p < .001); menthol preferring participants did not. Choice of higher nicotine cigarettes was associated with having reported a greater difference in positive reactions to NNC and VLNC for non-menthol preferring participants (F(1, 55)= 12.72, p < .001) but not for menthol preferring participants. ConclusionsYoung adults who smoke infrequently are a priority tobacco control population given their high risk of transitioning to daily smoking. Results from this study in the form of subjective reactions indicate that a menthol ban is required for a nicotine reduction standard to be maximally effective in this vulnerable group.

Smoking abstinence and cessation-related outcomes one month after an immediate versus gradual reduction in nicotine content of cigarettes

The United States Food and Drug Administration has the authority to reduce the nicotine content in cigarettes to minimal or non-addictive levels and could do so immediately or gradually over time. A large clinical trial compared the two approaches. This secondary analysis assesses abstinence and cessation-related outcomes one month after the trial concluded, when participants no longer had access to very low nicotine content (VLNC) research cigarettes. Smokers not interested in quitting (N = 1250) were recruited for the parent trial from 2014 to 2016 across 10 sites throughout the US and randomized to a 20-week study period during which they immediately switched to VLNC cigarettes, gradually transitioned to VLNC cigarettes with five monthly dose reductions, or smoked normal nicotine research cigarettes (control). At the one-month follow-up, both immediate and gradual reduction resulted in greater mean cigarette-free days (4.7 and 4.6 respectively) than the control group (3.2, both p < .05). Immediate reduction resulted in fewer mean cigarettes per day (CPD = 10.3) and lower Fagerström Test for Cigarette Dependence (FTCD = 3.7) than the gradual (CPD = 11.7, p = .001; FTCD = 3.8, p = .039) and control (CPD = 13.5, p < .001; FTCD = 4.0, p < .001) groups. Compared to controls, gradual reduction resulted in reduced CPD (p = .012) but not FTCD (p = .13). Differences in CO-verified 7-day point-prevalence abstinence were not significant. Findings demonstrate that switching to VLNC cigarettes resulted in reduced smoking and nicotine dependence severity that was sustained for at least a month after the VLNC trial period in smokers who were not interested in cessation. The greatest harm reduction endpoints were observed in those who immediately transitioned to VLNC cigarettes.

Concept of BIDI years: Relevance to the perioperative period.

Background:The cumulative effect of cigarette smoking is usually measured by “pack years,” but the same is not present for Bidis. This study was conducted to calculate the concept of “bidi years” in comparison to the concept of “pack-years” for a cigaretteMethods:Thirty random samples, each of bidis and cigarettes, were selected through a survey of common brands used by smokers in India. The nicotine and carbon monoxide (CO) contents were analyzed by high-pressure liquid chromatography and gas chromatography methods, respectivelyResults:The average nicotine content in thirty samples of different Bidis and Cigarettes was 214.46 ± 57.8 and 616.31 ± 22.6 mg/dL, respectively (P < 0.001). The CO content with a lower mean of 15.57 ± 5.88 was observed in cigarettes as compared to 70.4 ± 22.08 in bidies (P < 0.001). The weight of one cigarette is 0.56 times that of the weight of one bidi. Based on the nicotine content, the equivalent pack years for bidis is calculated as 43 bidis per day per yearConclusion:Based on the nicotine content, it is proposed that the equivalent for one cigarette pack-year or 20 cigarette years are taken as 43 bidis per day per year. Even though each bidi stick has an average of 0.46 times the nicotine content of cigarettes, longer abstinence as compared to cigarette is required to bring the nicotine level to normal due to the deeper puffs needed. With the CO content of bidis being 4.5 times that of cigarettes, it is advised that the minimum duration of cessation of smoking before operative procedures be 24 h as compared to 6 h for cigarettes.

Predictors of Adherence Among Vulnerable Populations of Adults Assigned to Smoke Very Low Nicotine Content Cigarettes.

Regulators are considering reducing the nicotine content in cigarettes to a minimally addictive level. This could particularly benefit smokers from populations vulnerable to heavy smoking and difficulties quitting. We assessed predictors of adherence among adults from vulnerable populations assigned to use very low nicotine content cigarettes (VLNCs) in randomized clinical trials, to identify characteristics of those who require additional assistance if a nicotine reduction policy were implemented. Data came from three populations of vulnerable adult smokers assigned to use VLNC cigarettes (0.4 mg/g nicotine) during 12-week randomized controlled trials (n = 286): Socioeconomically disadvantaged women of reproductive age, opioid-maintained adults, and adults with affective disorders. Logistic and linear regressions modeled predictors of adherence based on changes in cotinine at week-6 and week-12 assessments relative to baseline, and as a 90% reduction in cotinine relative to baseline (full adherence: yes/no). Predictors included satisfaction with study cigarettes, craving, nicotine dependence severity, withdrawal, population membership, baseline affective-disorder symptoms, and sociodemographic characteristics. Dependence severity was negatively associated with both adherence measures at week 6 (p < .01), whereas increased satisfaction with study cigarettes and age were positively associated with both measures at weeks 6 and 12 (p < .01). Opioid-maintained adults exhibited reduced adherence and were less likely to reach full adherence at week 12 compared to disadvantaged women (p = .02). Factors associated with VLNC adherence in vulnerable populations are similar to those in the general population of smokers. Furthermore, studies are indicated investigating nicotine supplements (e.g., e-cigarettes, NRT) to support highly dependent adults faced with using VLNCs. This study identified factors predicting difficulty maintaining adherence to a regimen of very low nicotine content cigarettes (VLNC) among adults from vulnerable populations. Findings suggested that factors predicting difficulty maintaining adherence (greater nicotine dependence and low satisfaction with study-provided VLNC) were common across vulnerable smokers and the general population of adults who smoke. Furthermore, research should investigate alternatives to support highly dependent adults, such as pairing VLNC with supplemental, noncombusted nicotine. Some vulnerable populations (e.g., opioid-maintained adults) may be especially in need of supplemental, noncombusted nicotine.