EVALUATING THE EFFECTS OF ELECTRONIC NICOTINE DELIVERY SYSTEMS ON SMOKING REDUCTION, NEGATIVE MOOD, AND STRESS AMONG SMOKERS WITH MENTAL ILLNESS

Introduction: Smokers with mental illness (MI) are disproportionately affected by negative health outcomes. Electronic nicotine delivery systems (ENDS) may represent a harm reduction tool for those who reduce and/or replace their cigarettes with ENDS. Little previous research has examined how smokers with MI respond to ENDS. This analysis aimed to address this research gap using secondary data from a randomized controlled trial of ENDS varying in nicotine delivery among smokers with and without current MI. The aims were to test 1) the effects of MI status, condition, and time on changes in smoking behavior and negative mood and stress measures, 2) whether changes in negative mood and stress mediate condition-related effects on smoking, and 3) whether this mediation was moderated by MI status. Methods: Smokers (n=520) interested in reduction but not cessation were randomized to receive either a non-nicotine-containing plastic cigarette substitute (CIG SUB) or ENDS differing in liquid nicotine concentration (0, 8, or 36 mg/ml) for 24 weeks. MI status was assessed at baseline. Smoking behavior (cigarettes per day; CPD) and negative mood (depression, psychological distress) and perceived stress measures were assessed at week 0, 4, 8, 16, and 24. Conditions were collapsed by nicotine-containing status (CIG SUB/0 mg/ml vs. 8/36 mg/ml), and participants were categorized by MI status (yes, no). Linear mixed models and mediation models were used. Sensitivity analyses included covariate adjustment. Results: CPD reduction was significantly greater among smokers without MI at week 16 and 24 for the unadjusted analysis only. Nicotine conditions were associated with significantly greater CPD reduction at all time points, and both condition groupings resulted in significant CPD reduction relative to baseline. Significantly greater depressive symptoms were observed for non-nicotine conditions at week 4; significantly greater psychological distress was observed for non-nicotine conditions at week 24. With covariate adjustment, negative mood measures were significantly higher at later study time points for those with MI. Perceived stress differed by MI status but not condition grouping. Changes in negative mood and stress did not mediate CPD reduction, but direct effects of condition as well as changes in negative mood on CPD reduction were observed. Conclusions: Our findings indicate that smokers with MI may experience greater difficulty reducing CPD, but nicotine conditions had similar effectiveness in reducing CPD relative to non-nicotine conditions among smokers with and without MI. Smokers with MI reported increased negative mood at some time points, but changes in negative mood and stress did not explain the relationship between condition and CPD reduction. Results highlight the need for mood management during smoking reduction and cessation efforts for smokers with MI and support the idea that ENDS may be an effective tool for smoking reduction for this group

Triangulating Abuse Liability Assessment for Flavoured Cigar Products Using Physiological, Behavioural Economic and Subjective Assessments: A Within-subjects Clinical Laboratory Protocol

Introduction In the USA, Food and Drug Administration regulations prohibit the sale of flavoured cigarettes, with menthol being the exception. However, the manufacture, advertisement and sale of flavoured cigar products are permitted. Such flavourings influence positive perceptions of tobacco products and are linked to increased use. Flavourings may mask the taste of tobacco and enhance smoke inhalation, influencing toxicant exposure and abuse liability among novice tobacco users. Using clinical laboratory methods, this study investigates how flavour availability affects measures of abuse liability in young adult cigarette smokers. The specific aims are to evaluate the effect of cigar flavours on nicotine exposure, and behavioural and subjective measures of abuse liability. Methods and analyses Participants (projected n=25) are healthy smokers of five or more cigarettes per day over the past 3 months, 18–25 years old, naive to cigar use (lifetime use of 50 or fewer cigar products and no more than 10 cigars smoked in the past 30 days) and without a desire to quit cigarette smoking in the next 30 days. Participants complete five laboratory sessions in a Latin square design with either their own brand cigarette or a session-specific Black & Mild cigar differing in flavour (apple, cream, original and wine). Participants are single-blinded to cigar flavours. Each session consists of two 10-puff smoking bouts (30 s interpuff interval) separated by 1 hour. Primary outcomes include saliva nicotine concentration, behavioural economic task performance and response to various questionnaire items assessing subjective effects predictive of abuse liability. Differences in outcomes across own brand cigarette and flavoured cigar conditions will be tested using linear mixed models

Influence of electronic cigarette characteristics on susceptibility, perceptions, and abuse liability indices among combustible tobacco cigarette smokers and non-smokers.

This study assessed how electronic cigarette (ECIG) characteristics amenable to regulation-namely nicotine content, flavor, and modified risk messages-impact ECIG use susceptibility, harm/addiction perceptions, and abuse liability indices among combustible tobacco cigarette (CTC) smokers and non-smokers. CTC smokers and non-smokers varying in ECIG use recruited via Amazon Mechanical Turk (MTurk) completed an online survey in 2016 (analytic = 706). Participants were randomly assigned to one of eight conditions differing in ECIG characteristics: nicotine content (no, low, high), flavor (menthol, tobacco, fruit), or modified risk message (reduced harm, reduced carcinogen exposure). Regressions assessed ECIG susceptibility, harm/addiction perceptions, and abuse liability indices (purchase task measures of breakpoint/intensity) within each regulatory domain (nicotine content, flavor, message) and their interactions with CTC/ECIG status. Differential effects on ECIG susceptibility, harm/addiction perceptions, and abuse liability indices were observed by regulatory domain with many effects moderated by CTC/ECIG status. ECIG nicotine content and flavor conditions were the most influential across outcomes. Greater nicotine content, tobacco-flavored and reduced carcinogen exposure ECIGs were more highly preferred by CTC smokers with some differing preferences for non-users. Findings reinforce consideration of discrete ECIG preferences across tobacco use status to improve regulatory efficacy

Influence of Electronic Cigarette Characteristics on Susceptibility, Perceptions, and Abuse Liability Indices among Combustible Tobacco Cigarette Smokers and Non-Smokers

This study assessed how electronic cigarette (ECIG) characteristics amenable to regulation—namely nicotine content, flavor, and modified risk messages—impact ECIG use susceptibility, harm/addiction perceptions, and abuse liability indices among combustible tobacco cigarette (CTC) smokers and non-smokers. CTC smokers and non-smokers varying in ECIG use recruited via Amazon Mechanical Turk (MTurk) completed an online survey in 2016 (analytic n = 706). Participants were randomly assigned to one of eight conditions differing in ECIG characteristics: nicotine content (no, low, high), flavor (menthol, tobacco, fruit), or modified risk message (reduced harm, reduced carcinogen exposure). Regressions assessed ECIG susceptibility, harm/addiction perceptions, and abuse liability indices (purchase task measures of breakpoint/intensity) within each regulatory domain (nicotine content, flavor, message) and their interactions with CTC/ECIG status. Differential effects on ECIG susceptibility, harm/addiction perceptions, and abuse liability indices were observed by regulatory domain with many effects moderated by CTC/ECIG status. ECIG nicotine content and flavor conditions were the most influential across outcomes. Greater nicotine content, tobacco-flavored and reduced carcinogen exposure ECIGs were more highly preferred by CTC smokers with some differing preferences for non-users. Findings reinforce consideration of discrete ECIG preferences across tobacco use status to improve regulatory efficacy

Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan

Background Little is known about tobacco use among youth exposed to armed conflicts, or the influence of trauma on tobacco use in this context. This study examined patterns of smoking by tobacco product and gender among Syrian refugee youth living in host communities in Jordan and assessed the associations of post-traumatic stress disorder (PTSD) and depression symptoms, trauma exposure and social support with current smoking status in boys and girls. Methods Syrian refugee students (mean [standard deviation] age = 14.9 [1.33] years) were identified through the public school system. Data were collected using an online Arabic questionnaire that included questions about demographics, trauma exposure, current smoking (cigarette and waterpipe), PTSD, depression and perceived social support. Logistic regression was used to assess the adjusted effects of independent variables on current smoking status. Results One in 7 boys and one in 14 girls were current smokers, with boys reporting greater tobacco use than girls. Among boys, current smokers reported significantly higher family member loss and lower perceived family social support than nonsmokers; among girls, current smokers also reported significantly higher family member loss as well as greater PTSD symptoms and lower perceived significant other/special person social support. Conclusions Tobacco use is established among this vulnerable group. The findings highlight the potential role of psychosocial support for tobacco prevention and cessation strategies