Trial Of Cigarettes Research Articles

Underreporting of non-study cigarette use by study participants confounds the interpretation of results from ambulatory clinical trial of reduced nicotine cigarettes

BackgroundAs part of its comprehensive plan to significantly reduce the harm from tobacco products, the US Food and Drug Administration is establishing a product standard to lower nicotine in conventional cigarettes to make them “minimally addictive or non-addictive". Many clinical studies have investigated the potential impact of such a standard on smoking behavior and exposure to cigarette constituents. These ambulatory studies required participants who smoke to switch to reduced nicotine study cigarettes. In contrast to clinical trials on pharmaceuticals or medical devices, participants had ready access to non-study conventional nicotine cigarettes and high rates of non-study cigarette use were consistently reported. The magnitude of non-compliance, which could impact the interpretation of the study results, was not adequately assessed in these trials.MethodsWe conducted a secondary analysis of data from a large, randomized trial of reduced nicotine cigarettes with 840 participants to estimate the magnitude of non-compliance, i.e., the average number of non-study cigarettes smoked per day by study participants assigned to reduced nicotine cigarettes. Individual participants’ non-study cigarette use was estimated based on his/her urinary total nicotine equivalent level, the nicotine content of the study cigarette assigned and the self-reported number of cigarettes smoked, using a previously published method.ResultsOur analysis showed that (1) there is a large variation in the number of non-study cigarettes smoked by participants within each group (coefficient of variation 90–232%); (2) participants in reduced nicotine cigarette groups underreported their mean number of non-study cigarettes smoked per day by 85–91%; and (3) the biochemical-based estimates indicate no reduction in the mean number of total cigarettes smoked per day for any group assigned to reduced nicotine cigarettes after accounting for non-study cigarettes.ConclusionsHigh levels of non-compliance, in both the rate and magnitude of non-study cigarette use, are common in ambulatory reduced nicotine cigarette trials where participants have access to conventional nicotine non-study cigarettes. The potential impact of high non-compliance on study outcomes should be considered when interpreting the results from such ambulatory studies.

Subjective experiences, contexts, and risk perceptions of very low nicotine content cigarettes and electronic cigarettes among people with depression and anxiety disorders who smoke

BackgroundA low-nicotine product standard is currently under consideration by the U.S. Food and Drug Administration (FDA). This standard may be more effective if alternative, non-combusted sources of nicotine are concurrently available. This qualitative study explored the lived experiences of people with depression and anxiety disorders who used very low nicotine content (VLNC) cigarettes with or without e-cigarettes during a randomized controlled trial. MethodsWe conducted semi-structured qualitative interviews with participants (n = 20) as they completed a 16-week blinded trial of VLNC cigarettes with or without electronic cigarettes. Interviews explored 1) experiences with these products, 2) social and environmental contexts for use and 3) relative risk perceptions. Interviews were transcribed and analyzed using a hybrid inductive and deductive thematic analysis. ResultsConcurrent access to e-cigarettes helped to ease the transition from usual-brand cigarettes to VLNC cigarettes. Some participants held misperceptions that VLNC cigarettes could reduce cancer risk whereas others did not. Participants expressed skepticism about the safety of e-cigarettes and the authenticity of the VLNC cigarettes. Smoking restrictions influenced e-cigarette use in some instances, but product preference was the overriding factor that influenced use. Participants did not note effects on psychiatric symptoms. ConclusionsShould a nicotine reduction policy be implemented with e-cigarettes concurrently available on the market, tailored messaging for people with anxiety and depression disorders may be necessary to educate people about and the availability of alternative sources of nicotine, such as e-cigarettes, as well as the relative risk of VLNC cigarettes and e-cigarettes.

The impact of three weeks of pre-quit varenicline on reinforcing value and craving for cigarettes in a laboratory choice procedure.

Varenicline, a partial nicotinic agonist, is theorized to attenuate pre-quit smoking reinforcement and post-quit withdrawal and craving. However, the mechanisms of action have not been fully characterized, as most studies employ only retrospective self-report measures, hypothetical indices of reinforcing value, and/or nontreatment-seeking samples. The current research examined the impact of pre-quit varenicline (vs. placebo) on laboratory measures of smoking and food (vs. water) reinforcement and craving. Participants were 162 treatment-seeking smokers enrolled in a randomized controlled trial of smoking cessation ( clinicaltrials.gov ID: NCT03262662). Participants completed two laboratory sessions: a pre-treatment session, ~ 1 week prior to beginning varenicline or placebo, and an active treatment session, after ~ 3 weeks of treatment. At each session, participants completed a laboratory choice procedure; on each of 36 trials, a lit cigarette, food item, or cup of water was randomly presented. Participants reported level of craving and spent $0.01-0.25 to have a corresponding 5-95% chance to sample the cue. As predicted, spending was significantly higher on cigarette trials than water trials, and varenicline resulted in a greater between-session decline in spending on cigarette trials (but not water) than did placebo. Cigarette craving was enhanced in the presence of smoking cues compared to water, but neither average (tonic) cigarette craving nor cue-specific cigarette craving was significantly influenced by varenicline. Food spending and craving were generally unaffected by varenicline treatment. These laboratory data from treatment-seeking smokers provide the strongest evidence to date that varenicline selectively attenuates smoking reinforcement prior to quitting.

A fully Bayesian mixture model approach for identifying noncompliance in a regulatory tobacco clinical trial.

Identifying noncompliance in a randomized trial is challenging, but could be improved by leveraging biomarker data to identify participants that did not comply with their assigned treatment. For randomized trials of very low nicotine content (VLNC) cigarettes, the biomarker of total nicotine equivalents (TNE) could be used to identify noncompliance. Compliant participants should have lower levels of TNEs than participants that did not comply and smoked normal nicotine content cigarettes, resulting in a mixture of compliant and noncompliant participants at each dose level. Thresholds of TNE could then be identified from the compliant groups at each dose level and used to determine which study participants were compliant. Furthermore, proposed biological relationships of TNE with nicotine dose could be incorporated into improve the efficiency of estimation, but may introduce bias if misspecified. To account for multiple modeling assumptions across dose levels, we explore model averaging via reversible jump markov chain monte carlo (MCMC) within each dose level to take advantage of improvements in efficiency when the proposed relationship is true and to downweight the biological model when it is misspecified. In simulation studies, we demonstrate that model averaging in the presence of a correct biological relationship results in a decrease in the mean square error (MSE) of up to 85%, but downweights the model in dose levels where the relationship is not appropriate. We apply our approach to data from a randomized trial of VLNC cigarettes to estimate TNE thresholds and probability of compliance curves as a function of TNEs for each nicotine dose used in the trial.

Randomized Trial of Low-Nicotine Cigarettes and Transdermal Nicotine

A mandated reduction in the nicotine content of cigarettes may decrease smoking, but also increase demand for other nicotine products. The present study tested the impact of smoking cigarettes with very low nicotine content and concurrent use of a transdermal nicotine patch. A balanced 2 × 2 factorial randomized clinical trial investigating the impact of cigarette nicotine content (double-blind, very low nicotine content versus normal nicotine content) and use of a transdermal nicotine patch (open label, patch versus no patch). Adult daily smokers (n=240) in the Pittsburgh, PA area. Participants were provided with research cigarettes and transdermal nicotine patches (if assigned to patch condition) for 7 weeks. Cigarettes were Spectrum brand (National Institute on Drug Abuse) and either 15.8 mg nicotine/g tobacco (normal nicotine content) or 0.4 mg nicotine/g tobacco (very low nicotine content). In the 7th week, participants were monetarily incentivized to abstain from smoking. Participants reported daily cigarette use throughout the trial and the primary outcome was average number of cigarettes smoked per day (study + nonstudy) during Week 6. Participants were recruited from 2015 to 2017 and data were analyzed between 2017 and 2018. Assignment to very low nicotine content cigarettes and assignment to wear a nicotine patch both reduced the number of cigarettes smoked per day during Week 6 (p=0.001 and 0.04, respectively). However, assignment to the patch along with very low nicotine content cigarettes did not significantly reduce cigarette smoking compared with assignment to very low nicotine content cigarettes alone. A mandated reduction in the nicotine content of cigarettes is likely to reduce the number of cigarettes smoked per day, but the added benefit of concurrent transdermal nicotine is unclear. Future studies should investigate whether alternative sources of noncombusted tobacco, such as e-cigarettes, enhance the effects of very low nicotine content cigarettes on smoking. This study is registered at www.clinicaltrials.gov NCT02301325.

Correlates of support for a nicotine-reduction policy in smokers with 6-week exposure to very low nicotine cigarettes

BackgroundThe US Food and Drug Administration recently issued an advanced notice of proposed rule-making for reducing the nicotine content in cigarettes to a minimally addictive level. Very little is known...

“Technophilia”: A new risk factor for electronic cigarette use among early adolescents?

PurposeDevelop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents. MethodsSurvey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product. ResultsTechnophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AORQ4 vs Q1 = 1.36, 95% CI 1.14–1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AORQ4vQ1 = 1.66, 95% CI 1.20–2.31; AORQ3vQ1 = 1.43, 95% CI 1.02–2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products. ConclusionThis study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.

Passive Upper Airway Thermoregulation and High-Speed Assessment for Conventional versus Menthol Cigarette: Implications for Laryngeal Physiology

This investigation combined measures of upper airway temperature (UAT) with high-speed laryngeal imaging in an individual who smoked a filtered conventional and menthol cigarette to identify laryngeal vibratory differences with upper airway temperature change. It was hypothesized that (1) average UAT differences between trials would be similar with UAT change ≤2°C and (2) high-speed parameters would not differ between trials. In a repeated measures design, UAT was measured continuously during smoking. High-speed laryngeal imaging was conducted immediately after each smoking trial and 10 minutes post. Average UAT and end-inspiratory temperature during the menthol trial was unexpectedly low. Immediately following both trials, there was an increase in phase asymmetry, vibratory amplitude (greater magnitude of change for the nonmenthol trial), and the opening phase of the glottal cycle and a decrease in fundamental frequency compared to the baseline. During recovery, parameters returned to the baseline for the nonmenthol trial, however, fundamental frequency continued to be lower and vibratory amplitude continued to be larger at recovery for the menthol trial. The measure of oscillatory onset time did not change across the trials immediately post cigarette trial and during recovery suggesting that smoking resulted in changes in sustained vibratory function rather than the onset behavior. Preliminary findings suggest that continuous thermal mapping and high-speed laryngeal function assessment may provide new information about the manner in which laryngeal tissue responds to passive thermal perturbations with direct implications for laryngeal epithelial and skeletal muscle function. Future large-scale studies are needed to investigate this in detail.

Patterns of E-Cigarette Use Among Youth and Young Adults: Review of the Impact of E-Cigarettes on Cigarette Smoking.

The present article provides a review of the impact of e-cigarette use on subsequent cigarette smoking among youth and YAs. Studies presented here suggest that e-cigarette use among nonsmokers is associated with subsequent cigarette smoking, but study designs are subject to numerous limitations. Future research should focus on addressing the characteristics that put youth and YAs at the risk of using either product and how appeal and accessibility of these products are related to product use in order to inform future policy-making.

How to Think-Not Feel-about Tobacco Harm Reduction.

The debate over tobacco harm reduction (THR) has divided the tobacco control community into two camps, one expressing serious reservations about THR whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market. The often emotional debate would benefit from dispassionate data-based evaluation of evidence. After briefly discussing harm reduction in public health and specifically in tobacco control, this paper identifies major issues concerning e-cigarettes and reviews relevant evidence. Issues include: e-cigarettes' risks compared to cigarette smoking; the effect of vaping on youth smoking; vaping's impact on adult smoking cessation; the net long-term public health implications of vaping; and differences in views on policy issues. The intent is to provide a broad overview of issues and evidence, directing readers to more detailed reviews of specific issues. Principal findings include the following: (1) while longitudinal studies suggest that vaping increases never-smoking young people's odds of trying smoking, national survey data indicate that adolescents' 30-day smoking prevalence decreased at an unprecedented rate precisely whereas vaping increased. Use of all other tobacco products also declined. (2) Recent population-level studies add evidence that vaping is increasing adult smoking cessation. (3) Vaping is likely to make a positive contribution to public health. THR can be a complement to, not a substitute for, evidenced-based tobacco control interventions. Tobacco control professionals need to focus on objective assessment of and discussion about the potential costs and benefits of THR. Participants on both sides of the divisive THR debate need to examine the complicated issues and evidence more objectively. This entails considering both the potential benefits and costs associated with reduced-risk products like e-cigarettes. Furthermore, it requires examining different kinds of evidence when considering specific issues. For example, those concerned by longitudinal study findings that vaping increases students' trial of cigarettes should consider US national survey evidence that youth smoking has decreased at an unprecedented rate. A review of the major issues suggests that the potential of vaping to assist adult smokers to quit outweighs the potential negatives.

Never, non-daily, and daily smoking status and progression to daily cigarette smoking as correlates of major depressive episode in a national sample of youth: Results from the National Survey of Drug Use and Health 2013 to 2015

BackgroundCigarette smoking is associated with depression, and new initiates who progress more quickly to daily smoking may be at enhanced risk. In a nationally representative sample of youth, this study examined the association between daily, non-daily, and never smoking with past-year and lifetime major depressive episode (MDE) and, among daily smokers, whether faster progression to daily smoking was associated with increased MDE risk. MethodsData were from n = 44,921 youth aged 12–17 in the 2013–2015 National Survey on Drug Use and Health. Weighted adjusted multivariable logistic regression models were used to examine the association of smoking status (daily, non-daily, never) with lifetime and past-year MDE, and the association between progression from cigarette trial to daily smoking with MDE outcomes among daily smokers. ResultsDaily and non-daily smokers had similar rates of lifetime and past-year MDE; rates of MDE were approximately 50% lower among never smokers. Compared to never smokers, adjusted models showed that non-daily smokers had a higher risk of past-year and lifetime MDE, while daily smokers had a higher risk of past-year but not lifetime MDE. Daily smoking youth who progressed more quickly from cigarette trial to daily use had an increased risk of both lifetime and past-year MDE. ConclusionsPrevention programs should target factors associated with the shift from cigarette experimentation to regular use to curb deleterious consequences of use.

Acute effect of smoking and smoking abstinence on energy intake and appetite-related hormones blood concentrations

The effect of smoking on energy balance and the underlying mechanisms are not fully understood. The aim of the present study is to examine the acute effect of smoking and its abstinence on energy intake, subjective feelings of appetite and related hormones. Fourteen healthy smokers participated in a randomized, crossover study consisting of two trials: the Cigarette trial (participants smoked two cigarettes of their brand within 15min) and the Sham trial (they were asked to hold the cigarette as smoking, but without lighting it). After 45min the participants were offered an ad libitum variety of snacks, and their intake was recorded. Blood samples were taken at fasting, before the ad libitum meal and 1h after and were analyzed for obestatin, ghrelin, glucagon-like peptide-1, cholecystokinin and insulin levels. Subjective feelings of hunger, satiety and desired to eat, as well as smoking craving were evaluated by visual analog scales. Mean energy intake at the ad libitum meal was 825±310kcal in the Sham trial and 673±245kcal in the Cigarette trial (p=0.010). No significant intervention effects were observed for the reported appetite feelings or the appetite-related hormones levels. In conclusion, smoking was found to have an acute effect on dietary intake; this was not explained by changes in the hormonal levels that were evaluated. More research is needed to confirm these results in more prolonged periods of abstinence and explore other pathways through which smoking and its abstinence affect energy balance.

A longitudinal study of electronic cigarette use and onset of conventional cigarette smoking and marijuana use among Mexican adolescents

PurposeThis study evaluated whether e-cigarette trial among Mexican adolescents increased the likelihood of trial and use of conventional cigarettes or marijuana use at follow-up. MethodA school-based longitudinal survey was conducted in 60 public middle schools from the three largest cities in Mexico. Students (12–13 years old) were surveyed in 2015 and followed up 20 months later (n = 6574). Generalized estimating equations models were used to evaluate the association between e-cigarette trial at baseline and conventional cigarettes smoking and marijuana use at follow-up. ResultAdolescents who had tried e-cigarettes (but not cigarettes) at baseline were more likely to have tried conventional cigarettes at followup compared to adolescents who had tried neither e-cigarettes nor cigarettes (43% vs. 24%, respectively; RR 1.41, 95% CI 1.18-1.70). We also found that adolescents who had tried both conventional cigarettes and e-cigarettes at baseline were more likely to have tried marijuana at follow-up compared to adolescents who had tried neither tobacco product (20% vs. 4%, respectively; RR 2.67, 95% CI 1.78–4.02). Trial of only e-cigarettes was not independently associated with marijuana use at followup. ConclusionsAdolescents who had tried e-cigarettes were more likely to have tried conventional cigarettes and marijuana 20 months later. Although e-cigarettes have been banned in Mexico, it is likely that additional policies and public health campaigns are needed to reduce adolescent use of e-cigarettes and its consequences.

Estimating causal effects from a randomized clinical trial when noncompliance is measured with error.

Noncompliance or non-adherence to randomized treatment is a common challenge when interpreting data from randomized clinical trials. The effect of an intervention if all participants were forced to comply with the assigned treatment (i.e., the causal effect) is often of primary scientific interest. For example, in trials of very low nicotine content (VLNC) cigarettes, policymakers are interested in their effect on smoking behavior if their use were to be compelled by regulation. A variety of statistical methods to estimate the causal effect of an intervention have been proposed, but these methods, including inverse probability of compliance weighted (IPCW) estimators, assume that participants' compliance statuses are reported without error. This is an untenable assumption when compliance is based on self-report. Biomarkers (e.g., nicotine levels in the urine) may provide more reliable indicators of compliance but cannot perfectly discriminate between compliers and non-compliers. However, by modeling the distribution of the biomarker as a mixture distribution and writing the probability of compliance as a function of the mixture components, we show how the probability of compliance can be directly estimated from the data even when compliance status is unknown. To estimate the causal effect, we develop a new approach which re-weights participants by the product of their probability of compliance given the observed data and the inverse probability of compliance given confounders. We show that our proposed estimator is consistent and asymptotically normal and show that in some situations the proposed approach is more efficient than standard IPCW estimators. We demonstrate via simulation that the proposed estimator achieves smaller bias and greater efficiency than ad hoc approaches to estimating the causal effect when compliance is measured with error. We apply our method to data from a recently completed randomized trial of VLNC cigarettes.

Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior

IntroductionTobacco advertising can create false beliefs about health harms that are reinforced by product design features. Reduced nicotine content (RNC) cigarettes may reduce harm, but research has not addressed advertising influences. This study examined RNC cigarette advertising effects on false harm beliefs, and how these beliefs – along with initial subjective ratings of RNC cigarettes – affect subsequent smoking behaviors. We further explored whether subjective ratings moderate associations between false beliefs and behavior. MethodsSeventy-seven daily, non-treatment-seeking smokers (66.2% male) participated in the first 15days of a randomized, controlled, open-label RNC cigarette trial. Participants viewed an RNC cigarette advertisement at baseline before completing a 5-day period of preferred brand cigarette use, followed by a 10-day period of RNC cigarette use (0.6mg nicotine yield). Participants provided pre- and post-advertisement beliefs, and subjective ratings and smoking behaviors for cigarettes smoked during laboratory visits. ResultsViewing the advertisement increased beliefs that RNC cigarettes contain less nicotine and are healthier than regular cigarettes (p’s<0.001 and 0.011), and decreased the belief that they are less likely to cause cancer (p=0.046). Neither false beliefs nor subjective ratings directly affected smoking behaviors. Significant interactions of strength and taste ratings with beliefs (p’s<0.001), however, indicated that among smokers with less negative initial subjective ratings, greater false beliefs were associated with greater RNC cigarette consumption. ConclusionsSmokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.

Craving and tobacco use: Development of the choice behavior under cued conditions (CBUCC) procedure.

Many addiction theories propose that craving modulates smoking. Research on this relationship has yielded mixed results, which might be explained, in part, by a consideration of the various behaviors representing tobacco use. Tobacco use can be divided into seeking (attempts to access cigarettes) and consumption (ingestion of tobacco). Seeking can be further divided into behaviors that reflect the operation of automatic or nonautomatic cognitive processes. We developed a procedure (Choice Behavior Under Cued Conditions) to systematically examine the relationships between craving and these behaviors. Over multiple trials, thirty dependent smokers were exposed to a lit cigarette or a cup of water located behind a locked glass door. On each trial, participants rated craving and indicated the amount of money ($.01-$.25) they would spend to gain access to the cue. The amount spent, which determined the probability that the door would be unlocked and participants could sample the cue, indexed nonautomatic seeking. Latency to access the cue indexed automatic seeking behavior, and puff duration indexed consumption. Participants on average reported mild to moderate craving levels and had significantly higher craving and spent significantly more money on cigarette trials than water trials, though they did not access the cigarette more quickly than the water. Craving was significantly associated with money spent on cigarette trials (r = 0.54, p < .001) and puff duration (r = 0.38, p < .05), but not with latency (r = 0.35, p = .06). Overall, the data support the utility of this new procedure for examining the relationships between craving and various manifestations of tobacco use. (PsycINFO Database Record

Lung function and respiratory symptoms in a randomized smoking cessation trial of electronic cigarettes.

Quitting smoking is the most important step smokers can take to improve their health. Nonetheless, there is little information on long-term improvements in lung function and/or respiratory symptoms after smoking cessation. Here we illustrate long-term changes in spirometric indices as well as in respiratory symptoms in smokers invited to quit or reduce their cigarette consumption by switching to electronic cigarettes (ECs). Prospective evaluation of cigarette consumption, spirometry and symptoms was performed in a 1-year randomized controlled trial of smokers receiving EC containing 2.4%, 1.8% or 0% nicotine. Spirometric data are presented on the basis of participants' pooled continuous smoking phenotype classification (Quitters, Reducers, Failures), whereas respiratory symptoms on the basis of their point prevalence-smoking phenotype. Smoking phenotype classification (Quitters, Reducers, Failures) had no significant effect on spirometric indices (FEV1, FVC and FEV1/FVC) with the exception of FEF25-75%, which significantly (P =0.034) increased over the time among Quitters; their FEF25-75% (% predicted) improving from (means±S.D.) 85.7±15.6% at baseline (BL) to 100.8±14.6%. High prevalence of cough/phlegm (43.1%) and shortness of breath (SoB; 34.8%) was reported at BL with substantial reduction in their frequency at subsequent follow-up visits. These symptoms virtually disappeared very quickly in both quitters and reducers. Smokers invited to switch to ECs who completely abstained from smoking showed steady progressive improvements in their FEF25-75% Normalization of peripheral airways function was associated with improvement in respiratory symptoms, adding to the notion that abstaining from smoking can reverse tobacco harm in the lung.

Changes in breathomics from a 1-year randomized smoking cessation trial of electronic cigarettes.

Electronic cigarette (EC) use is an emerging behaviour that has been shown to help smokers to reduce cigarette consumption. The aim of this study was to illustrate long-term changes in exhaled breath measurements and respiratory symptoms in smokers invited to quit or reduce their cigarette consumption by switching to ECs. Prospective evaluation of cigarette consumption, fractional nitric oxide concentration in exhaled breath (FeNO), exhaled carbon monoxide (eCO) and symptom scores was performed in a 1-year randomized, controlled trial of 'healthy' smokers receiving 2·4% nicotine, 1·8% nicotine or no nicotine ECs. FeNO and eCO data are presented on the basis of participants' pooled continuous smoking phenotype classification (failures, reducers and quitters). A significant effect of quitting classification was found on FeNo and eCO at all time points (P < 0·0001). Among quitters, FeNO (medians and interquartile range) rose from 5·5 (4·5-6·9) ppb to 17·7 (13·3-18·9) ppb by week 52. Baseline eCO (medians and interquartile range) decreased from 17 (12-20) ppm to 3 (1-4) ppm by week 52. No significant changes in FeNO and eCO levels were observed in failures and reducers. Improvements in FeNO and eCO levels were correlated with attenuations in symptom scores. Smokers invited to switch to electronic cigarettes who completely abstained from smoking showed steady progressive improvements in their exhaled breath measurements and symptom scores. FeNo and eCO normalization is highly supportive of improved respiratory health outcomes and adds to the notion that quitting from tobacco smoking can reverse harm in the lung.

Impact of Exposure to Electronic Cigarette Advertising on Susceptibility and Trial of Electronic Cigarettes and Cigarettes in US Young Adults: A Randomized Controlled Trial.

This study assessed the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes in US young adults. A randomized controlled trial was conducted in a national sample of young adults from an online panel survey in 2013. Participants were randomized to ad exposure or control. Curiosity, intentions, and perceptions regarding e-cigarettes were assessed post-exposure and e-cigarette and cigarette use at 6-month follow-up. Analyses were conducted in 2014. Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette (18.3% exposed vs. 11.3% unexposed, AOR = 1.63, 95% CI = 1.18, 2.26) among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up (3.6% exposed vs. 1.2% unexposed, AOR = 2.85; 95% CI = 1.07, 7.61) among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users. Exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Future studies are needed to examine the net effect of curiosity and trial of e-cigarettes on longer-term patterns of tobacco use. This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes.

What Steps Should be Taken to Integrate Marijuana into Pain Regimens?

Pain ManagementVol. 5, No. 4 OpinionWhat steps should be taken to integrate marijuana into pain regimens?Mark Wallace & Timothy FurnishMark Wallace*Author for correspondence: E-mail Address: mswallace@ucsd.edu Division of Pain Medicine, Department of Anesthesiology, UCSD School of Medicine, 9300 Campus Point Drive, #7651, La Jolla, CA 92037, USASearch for more papers by this author & Timothy Furnish Division of Pain Medicine, Department of Anesthesiology, UCSD School of Medicine, 9300 Campus Point Drive, #7651, La Jolla, CA 92037, USASearch for more papers by this authorPublished Online:19 Jun 2015https://doi.org/10.2217/pmt.15.20AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail View articleKeywords: clinicalmedicinalmarijuanapracticeReferences1 Abrams DI, Jay CA, Shade SB et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68(7), 515–521 (2007).Crossref, Medline, CAS, Google Scholar2 Ellis RJ, Toperoff W, Vaida F et al. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34(3), 672–680 (2009).Crossref, Medline, CAS, Google Scholar3 Ware MA, Wang T, Shapiro S et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182(14), E694–E701 (2010).Crossref, Medline, Google Scholar4 Wilsey B, Marcotte T, Deutsch R et al. Low-dose vaporized cannabis significantly improves neuropathic pain. J. Pain 14(2), 136–148 (2013).Crossref, Medline, CAS, Google Scholar5 Wilsey B, Marcotte T, Tsodikov A et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J. Pain 9(6), 506–521 (2008).Crossref, Medline, CAS, Google Scholar6 Physician recommendation of medical cannabis: guidelines of the Council on Scientific Affairs subcommittee on medical marijuana practice advisory (2011). www.mbc.ca.gov/Licensees/Prescribing/medical_marijuana_cma-recommend.pdf.Google Scholar7 Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. CMAJ 178(13), 1669–1678 (2008).Crossref, Medline, Google Scholar8 Aryana A, Williams MA. Marijuana as a trigger of cardiovascular events: speculation or scientific certainty? Int. J. Cardiol. 118(2), 141–144 (2007).Crossref, Medline, Google Scholar9 Abrams DI, Vizoso HP, Shade SB et al. Vaporization as a smokeless cannabis delivery system: a pilot study. Clin. Pharmacol. Ther. 82(5), 572–578 (2007).Crossref, Medline, CAS, Google Scholar10 23 Legal medical marijuana states and DC: laws, fees, and possession limits. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881.Google Scholar11 Elikkottil J, Gupta P, Gupta K. The analgesic potential of cannabinoids. J. Opioid Manag. 5(6), 341–357 (2009).Crossref, Medline, Google Scholar12 Reisfield GM, Wasan AD, Jamison RN. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. Pain Med. 10(8), 1434–1441 (2009).Crossref, Medline, Google Scholar13 Borgelt LM, Franson KL, Nussbaum AM, Wang GS. The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy 33(2), 195–209 (2013).Crossref, Medline, CAS, Google Scholar14 Grant I, Atkinson JH, Gouaux B, Wilsey B. Medical marijuana: clearing away the smoke. Open Neurol. J. 6, 18–25 (2012).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited ByRational Urine Drug Monitoring in Patients Receiving Opioids for Chronic Pain: Consensus Recommendations1 December 2017 | Pain Medicine, Vol. 19, No. 1 Vol. 5, No. 4 Follow us on social media for the latest updates Metrics Downloaded 48 times History Published online 19 June 2015 Published in print July 2015 Information© Future Medicine LtdKeywordsclinicalmedicinalmarijuanapracticeFinancial & competing interests disclosureThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.PDF download