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Effects of immediate versus gradual nicotine reduction in cigarettes on biomarkers of biological effects
Author(s) -
Hatsukami Dorothy K.,
Luo Xianghua,
Heskin Alisa K.,
Tang Mei Kuen,
Carmella Steven G.,
Jensen Joni,
Robinson Jason D.,
Vandrey Ryan,
Drobes David J.,
Strasser Andrew A.,
al'Absi Mustafa,
Leischow Scott,
Cinciripini Paul M.,
Koopmeiners Joseph,
Ikuemonisan Joshua,
Benowitz Neal L.,
Donny Eric C.,
Hecht Stephen S.
Publication year - 2019
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.14695
Subject(s) - nicotine , medicine , confidence interval , cotinine , toxicant , tobacco smoke , nicotine dependence , physiology , environmental health , toxicity
Aim A previous study showed significantly greater reductions in number of cigarettes smoked and biomarkers of toxicant and carcinogen exposure in smokers assigned to immediate reduction of nicotine in cigarettes to very low levels versus gradually over time or continued smoking of normal nicotine content cigarettes. This study examines the effects of these approaches on selected biomarkers associated with harmful biological effects. Design Three‐arm, randomized controlled trial. Setting Ten United States academic institutional sites. Participants Daily smokers uninterested in quitting smoking with a mean age of 45.1 [standard deviation (SD) = 13.4)] years and smoking 17.1 (SD = 8.5) cigarettes/day; 43.9% (549 of 1250) female; 60.6% (758 of 1250) white ethnicity. Interventions (1) Smoking cigarettes where nicotine content was immediately reduced to very low levels ( n = 503); (2) smoking cigarettes where nicotine content was gradually reduced, with dose changes occurring monthly ( n = 498); and (3) continued smoking with normal nicotine content cigarettes ( n = 249). Measurements Smokers were assessed at baseline while smoking their usual brand cigarettes, and again at 4, 8, 12, 16 and 20 weeks. Outcomes were areas under the concentration time curve (AUC) for the period of study of biomarkers of inflammation, oxidative stress and hematological parameters. Findings No consistent significant differences were observed across groups (Bayes factors showing data to be insensitive), with the only exception being red blood cell size variability, which was observed to be lower in the immediate versus gradual nicotine reduction [mean difference = −0.11; 95% confidence interval (CI) = –0.18, −0.04, P = 0.004] and normal nicotine control groups (mean difference = − 0.15, 95% CI = –0.23, −0.06, P = 0.001). Conclusion It remains unclear whether switching to very low nicotine cigarettes leads to a short‐term reduction in biomarkers of tobacco‐related harm.