A review of the effects of very low nicotine content cigarettes on behavioral and cognitive performance

Keith, Diana R.; Kurti, Allison N.; Davis, Danielle R.; Zvorsky, Ivori; Higgins, Stephen T.

doi:10.1016/j.ypmed.2017.06.016

Cited by 9 publications

(9 citation statements)

References 51 publications

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“…Potential limitations of the policy include some people reducing cigarettes smoked per day but not achieving cessation, or continuing to use cigarettes for a multitude of reasons other than nicotine addiction,35 public misperceptions that VLNC cigarettes are harmful50 and potential (short-term) negative impacts on behavioural and cognitive performance following a rapid reduction in nicotine 36 51…”

Section: Resultsmentioning

confidence: 99%

Closing the gaps in tobacco endgame evidence: a scoping review

et al. 2022

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ObjectiveTobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities.Data sourcesGuided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched.Study selectionTwo reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation.Data extractionWe report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data synthesisEight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised.ConclusionsVLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

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Section: Resultsmentioning

confidence: 99%

Closing the gaps in tobacco endgame evidence: a scoping review

et al. 2022

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“…17–19 A recent review of the effects of VLNCs on behavioral and cognitive performance confirms these findings, reporting improved outcomes when VLNCs were used with nicotine replacement therapy. 96 Though there appears to be a considerable body of literature addressing this first phase of the risk assessment, the Tobacco Product Assessment Consortium framework could be used for a more fine-grained assessment of particular types of studies that might provide additional insights. 4…”

Section: Discussionmentioning

confidence: 99%

Nicotine Reduction in Cigarettes: Literature Review and Gap Analysis

Berman

Glasser

2019

Nicotine &Amp; Tobacco Research

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Background The US Food and Drug Administration (FDA) is considering reducing nicotine levels in cigarettes to “minimally or non-addictive levels.” However, important research gaps remain, and the FDA must determine when the available research is sufficient to support moving forward. Methods The authors conducted a systematic review of research articles in PubMed relating to nicotine reduction. Building on a review of risk assessment best practices, the authors also developed a risk assessment framework for tobacco regulation and used it to guide a gap analysis of nicotine reduction research. Results The final sample consisted of 78 articles. The majority examined either nicotine dependence on very low nicotine cigarettes (VLNCs) or markers of potential health effects of using VLNCs. One-third of the identified articles reported results from four large randomized controlled trials (RCTs). While these studies report promising results and suggest that a nicotine reduction rule would be a powerful tool to reduce cigarette smoking, our gap analysis suggests that there is a need for studies that better reflect the use and availability of a wide range of tobacco/nicotine products and the potential for dual- or multi-product use. Conclusion The current body of research on nicotine reduction is weighted towards RCTs, which is appropriate for a policy that has not yet been implemented anywhere in the world. The FDA must consider a wide range of factors that may impact a product standard’s public health impact, including those difficult to assess in RCTs, such as a nicotine reduction rule’s impact on smoking initiation and relapse. Implications This systematic review presents a gap analysis based on a risk assessment framework to help identify remaining research priorities to inform FDA’s potential product standard to reduce nicotine levels in cigarettes. Quickly addressing those gaps would support the FDA’s effort to develop a nicotine reduction product standard that will be effective and withstand legal challenges.

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“…Knowing whether reducing the nicotine content of cigarettes reduces the addiction potential of smoking even among more dependent smokers is important in assessing the potential impact that such a policy may have on existing smokers. Other important questions to examine are whether reduced nicotine content cigarettes adequately reduce withdrawal and craving and whether they may prompt compensatory smoking in more severely dependent smokers (Keith et al, 2017; US DHHS, 2001, 2010).…”

Section: Introductionmentioning

confidence: 99%

Response to reduced nicotine content cigarettes among smokers differing in tobacco dependence severity

Higgins

Bergeria

Davis

et al. 2018

Preventive Medicine

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This study examines whether tobacco dependence severity moderates the acute effects of reducing nicotine content in cigarettes on the addiction potential of smoking, craving/withdrawal, or smoking topography. Participants (N = 169) were daily smokers with mild, moderate, or high tobacco-dependence severity using the Heaviness of Smoking Index. Following brief abstinence, participants smoked research cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg nicotine/g tobacco) in a within-subject design. Results were analyzed using repeated measures analysis of co-variance. No main effects of dependence severity or interactions with nicotine dose were noted in relative reinforcing effects in concurrent choice testing or subjective effects on the modified Cigarette Evaluation Questionnaire. Demand for smoking in the Cigarette Purchase Task was greater among more dependent smokers, but reducing nicotine content decreased demand independent of dependence severity. Dependence severity did not significantly alter response to reduced nicotine content cigarettes on the Minnesota Tobacco Withdrawal Scale nor Questionnaire of Smoking Urges-brief (QSU) Factor-2 scale; dependence severity and dose interacted significantly on the QSU-brief Factor-1 scale, with reductions dependent on dose among highly but not mildly or moderately dependent smokers. Dependence severity and dose interacted significantly on only one of six measures of smoking topography (i.e., maximum flow rate), which increased as dose increased among mildly and moderately but not highly dependent smokers. These results suggest that dependence severity has no moderating influence on the ability of reduced nicotine content cigarettes to lower the addiction potential of smoking, and minimal effects on relief from craving/withdrawal or smoking topography.

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A review of the effects of very low nicotine content cigarettes on behavioral and cognitive performance

Cited by 9 publications

References 51 publications

Closing the gaps in tobacco endgame evidence: a scoping review

Closing the gaps in tobacco endgame evidence: a scoping review

Nicotine Reduction in Cigarettes: Literature Review and Gap Analysis

Response to reduced nicotine content cigarettes among smokers differing in tobacco dependence severity

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