Effect of Fruit and Mint Flavored Rogue Oral Nicotine Product Use on Smoking Reduction and Quitting in a 6-Month Prospective Cohort of Adults who Smoke Cigarettes

Abstract

Background Quitting cigarette smoking can substantially reduce or eliminate the risk of developing numerous chronic diseases. Use of flavored tobacco or nicotine products (TNP) is commonly cited by adults who smoke cigarettes to be important in helping them reduce or quit smoking. The purpose of this analysis was to understand the association between the levels of use of flavored oral nicotine products (ONP) and smoking reduction and quitting and how reduction or quitting may differ between predominant users of fruit/other versus mint flavored ONP after six months of use. Methods Participants were provided with their choice of a variety of forms and flavors of Rogue® nicotine products (Study Products, SP) over a 6-month actual use period (AUP) and completed online surveys assessing TNP and SP use at enrollment (Baseline) and Months 1, 2, 4, and 6 thereafter. Results Among the 1393 participants at Month 6, 41.4% and 52.5% used predominantly fruit/other or mint SP flavors, respectively. Compared to predominant mint users, predominant fruit/other users had greater cigarette reduction (mean reduction in CPD: 50.0% vs. 48.4%) and a higher proportion had quit smoking (proportion quit: 15.4% vs. 11.6%) at Month 6. Additionally, 37.6% of all participants, 38.8% of predominant fruit/other users, and 39.3% of predominant mint users reduced their average CPD by > 50% from Baseline. Increased use of fruit/other flavors was independently associated with smoking reduction (8.6% greater reduction per 10 pieces/day; p<0.001) and odds of quitting smoking (OR=1.29 [95% CI: 1.04-1.59] per 10 pieces/day; p=0.017). Increased use of mint flavors was independently associated with smoking reduction (7.5% greater reduction per 10 mint pieces/day; p<0.001) but not with odds of quitting smoking. Conclusions Increased quantity of fruit/other or mint flavored SP use was associated with significantly greater smoking reduction, and increased quantity of fruit/other flavors was associated with increased odds of quitting smoking in bivariate and multivariable models. The levels of reduction and quitting smoking observed during the study, with an increased benefit for use of fruit/other flavors, suggests that the availability of a variety of ONP flavors may provide an increased harm reduction benefit for adults who smoke cigarettes. Trial Registration This study was observational. Participants were not prospectively assigned to one or more health-related interventions and could choose to use or not use the commercially available study products provided during the study. Thus, the study was not registered in a trial database by the Sponsor.