Concurrent Associations Between Sweet And Cooling E-Cigarette Use And Combustible Cigarette Use And Quit Attempts Among Adult Dual Users

Combustible cigarette (CC) smoking is a leading cause of premature death in the United States. Federal regulators have signaled their intention to position electronic cigarettes (ECs) as a widely available, appealing, and well-regulated alternative nicotine product in the context of an overarching reduced nicotine content mandate in CCs. Prior research supports the efficacy of ECs as a smoking cessation tool in clinical contexts through the complete substitution of ECs for CCs. However, little data exists regarding the day-to-day naturalistic patterns of flavored EC use, or the role of non-tobacco flavored ECs in facilitating CC reduction and cessation. The current study examined the fine-grained naturalistic patterns of CC and flavored EC use among fifty-nine participants who used both products and desired to quit smoking CCs. Participants reported their daily use of both CCs and ECs over eight weeks. Study aims were to characterize flavored EC use patterns and investigate associations between the use of specific flavors of ECs and brief CC abstinence, CC reduction, and CC quit attempts. Sweet flavors were most commonly used by participants, followed by cooling- and tobacco-flavored ECs. Participants were statistically significantly more likely to be non-abstinent from CCs on days that they had used ECs, though this relationship was cross-sectional. Associations between the use of specific flavors of EC and CC cessation-related outcomes were not significant, suggesting that models were underpowered. Sensitivity analyses suggested that hybrid sweet/cooling flavors may be associated with different CC-related behavioral correlates than cooling-only flavors. Overall, findings suggest that participants who use ECs concurrently with CCs without external guidance may not intuit how to use ECs as complete substitutes for CCs. Research and policy related to flavored ECs must also grapple with issues of consistency in defining and categorizing different types of EC flavors

The impact of opioid agonist treatment on nicotine metabolism

Nicotine metabolite ratio (NMR) has been positively associated with increased cigarette consumption, greater lung cancer risk, and decreased smoking cessation. Opioid-dependent populations experience higher rates of smoking, difficulties with smoking cessation, and more negative smoking-related health outcomes compared to the general population of smokers. Opioid agonist treatment medications (OAT; i.e., methadone or buprenorphine) might influence NMR and thereby explain some of these disparities. The current study investigated the associations of OAT status (i.e., receiving OAT vs. no OAT), OAT type (i.e., methadone vs. buprenorphine), and OAT dose (i.e., low vs. high dose) on NMR in samples drawn from two prior studies examining the effects of very low nicotine content cigarettes among vulnerable smoker populations. Although OAT status per se was not significantly associated with NMR, methadone was significantly associated with higher NMR relative to those receiving buprenorphine or no OAT in one study sample. Exploratory analyses did not reveal a significant effect of methadone low vs. high dose on NMR, but an effect of buprenorphine dose was observed such that those receiving higher doses of buprenorphine had higher NMR relative to low doses. This suggests that methadone might be associated with increased nicotine metabolism, though the relationship between OAT and NMR is complex