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Estimations and predictors of non‐compliance in switchers to reduced nicotine content cigarettes
Author(s) -
Nardone Natalie,
Donny Eric C.,
Hatsukami Dorothy K.,
Koopmeiners Joseph S.,
Murphy Sharon E.,
Strasser Andrew A.,
Tidey Jennifer W.,
Vandrey Ryan,
Benowitz Neal L.
Publication year - 2016
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13519
Subject(s) - nicotine , cotinine , medicine , confidence interval , odds ratio , smoking cessation , demography , randomized controlled trial , volunteer , pathology , sociology , agronomy , biology
Background and Aims Clinical trials on the impact and safety of reduced nicotine content cigarettes (RNCs) are ongoing, and an important methodological concern is participant compliance with smoking only RNCs. Our aims were to measure non‐compliance biochemically with urine cotinine (COT) and total nicotine equivalents (TNEs), compare with self‐reported non‐compliance and identify associated covariates. Design Secondary analysis of a double‐blind, parallel, randomized clinical trial. Setting Research centers from the United States, enrolling participants from June 2013 to July 2014. Participants Volunteer sample of 242 participants (55% Caucasian), average age of 41.2 years, smoking at least five cigarettes per day (CPD). Intervention Smoking very low nicotine cigarettes (VLNCs; 0.4 mg nicotine/g tobacco) for 6 weeks. Measurements The primary outcome was biochemically verified non‐compliance, measured as thresholds of COT/CPD and TNE/CPD ratios, considering changes in nicotine content from conventional levels to VLNCs, and as an absolute threshold of week 6 TNEs. Self‐reported non‐compliance was measured via daily phone calls. Key predictors included age, sex, race, menthol preference, nicotine metabolite ratio, time to first cigarette, dependence, CPD, TNEs, tar level and cigarette evaluation. Findings Estimates of non‐compliance with smoking the VLNCs exclusively include: the biochemical ratios (both 78%), the week 6 TNE threshold (76%) and self‐report (39%). Of the key covariates, age, dependence and cigarette evaluations of satisfaction were significant; for age, younger participants more likely to be non‐compliant [ P = 0.01; odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.96–0.99]. Dependence was associated significantly with self‐reported non‐compliance ( P = 0.01; OR = 1.28, 95% CI = 1.06–1.55). Cigarette evaluations of satisfaction were associated significantly with non‐compliance ( P = 0.001; OR = 0.71, 95% CI = 0.61–0.82). Conclusions Among smokers volunteering to smoke only very low nicotine cigarettes for 6 weeks, non‐compliance was common and biochemical assessments detected more cases of non‐compliance than self‐report. Despite high levels of non‐compliance, smokers reduced their intake of nicotine by an average of 60%.