Reduced-nicotine cigarettes lead to less smoking in anxious and depressed smokers

Summary: Lowering nicotine levels to non-addictive levels reduces smoking without worsening symptoms of depression and anxiety in people with mental health conditions.

Source: Penn State

According to researchers from Penn State College of Medicine and Harvard Medical School, reducing the amount of nicotine in cigarettes to non-addictive levels can reduce smoking without worsening the mental health of smokers with mood or mood disorders. anxiety.

They said reducing the nicotine content of cigarettes could also reduce addiction, reduce exposure to toxic substances and increase a smoker’s chances of quitting.

Tobacco remains the leading preventable cause of premature death and disease in the United States. Recent proposals from the US Food and Drug Administration and the New Zealand government seek to limit the amount of nicotine in cigarettes to minimally addictive levels.

Previous research indicates that reducing nicotine content could help smokers quit smoking, but there is little evidence to demonstrate whether these policies could negatively affect smokers with current or past affective disorders such as depression and the disorders anxiety – which affects approximately 38% of American cigarette smokers.

According to Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health, smokers with mental disorders are more likely to have severe nicotine withdrawal symptoms and less successful quitting.

He also said there was speculation that reducing nicotine to very low levels could worsen psychiatric symptoms in mentally ill smokers and lead to increased smoking and increased exposure to substances. toxic or harmful chemicals.

The researchers studied 188 smokers with a history of or who had a mood or anxiety disorder and who had no intention of quitting.

Volunteer participants were randomly assigned to a group that received either research cigarettes containing the usual amount of nicotine (11.6 mg nicotine/cigarette) or a gradually reduced amount of nicotine for an additional 18 weeks ( the final amount was 0.2 mg of nicotine/cigarette).

At the start and end of the study, researchers measured levels of cotinine, a metabolite of nicotine, levels of harmful chemicals, indices of cigarette addiction, and various measures of mental health.

The researchers found no statistically significant difference in mental health measures between the two groups at the end of the study.

The team used the Kessler Psychological Distress Scale, a six-point self-report where participants reported on a 5-point scale the degree to which they experienced feelings or emotions such as ‘nervous’, ‘desperate’ or “so depressed that nothing could cheer them up.” Scores are developed by adding the points for the six experiences.

Participants in the reduced nicotine group scored an average of 5.3 at the start of the study and finished with an average score of 4.6, while participants in the usual nicotine group scored a from 6.1 at the start of the study and finished around 4.9.

“These results are important because we want to understand the effect these policies would have on smokers with anxiety or depressive disorders,” said Foulds, a researcher at the Penn State Cancer Institute.

“Our data showed that there was no significant difference in mental health measures between the groups, suggesting that reduced nicotine cigarettes may not have adverse psychological effects in this population. “

Similar to what previous studies have reported, Foulds and his team found that groups in the reduced nicotine group took in lower amounts of nicotine and ingested lower levels of harmful carcinogens such as the biomarker 4-(methylnitrosamino) -1-(3-pryidyl)-1-butanol), more commonly known as NNAL. This group also smoked fewer cigarettes and reported lower levels of nicotine dependence at the end of the randomized phase of the trial.

The results were published in PLOS ONE today, November 2.

Unique to this study, participants in both groups were also given the choice to “choose their treatment,” after the 18-week period. They could go back to using their own cigarettes, continue to smoke the research cigarettes, or try to quit.

Of the 188 study participants, those randomized to receive reduced nicotine cigarettes were more likely to have quit smoking 12 weeks later (18.1%), compared to those in the control group (usual strength in nicotine) (4.3%).

This shows white smoke on a black background
Tobacco remains the leading preventable cause of premature death and disease in the United States. Image is in public domain

“We believe this is the first randomized trial to find that smokers who used very low nicotine cigarettes were significantly more likely to have quit smoking (with biochemical verification), three months after quitting. the trial,” Foulds said.

“Our results suggest that these policies are likely to lead to reduced nicotine intake from cigarettes without worsening the mental health of smokers with mood or anxiety disorders,” said Dr. Eden Evins, professor of psychiatry at the Cox family at Harvard Medical School. “They also suggest that with appropriate support and resources, smokers with mood and anxiety disorders could quit successfully with these policies.”

For more information about nicotine, smoking, and health studies at the Penn State Center for Research on Tobacco and Health, visit https://research.med.psu.edu/smoking/#participants.

See also

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Susan Veldheer, Ahmad Hameed, Sophia Allen, Jessica Yingst, Erin Hammett, Jennifer Modesto, Nicolle Krebs, Courtney Lester, Neil Trushin, Lisa Reinhart, Emily Wasserman, Junija Zhu, Jason Liao, Joshua Muscat, and John Richie from Penn State College of Medicine ; Shari Hrabovsky of Penn State Ross and Carol Nese College of Nursing; and Gladys Pashas, ​​Corinne Cather, Nour Azzouz, and A. Edin Evins of Harvard Medical School also contributed to this research. Foulds and Evins have done paid consulting for pharmaceutical companies involved in the production of smoking cessation drugs. Other author conflicts of interest are noted in the manuscript.

Funding: This research was supported by the National Institutes of Health through the National Institute on Drug Abuse of the National Institutes of Health (award P50DA036107) and the National Center for Advancing Translational Sciences through the Penn State Clinical and Translational Science Institute (award UL1 TR000127). The research was also supported by the US Food and Drug Administration’s Center for Tobacco Products. The contents are the sole responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

About This Nicotine Addiction and Mental Health Research News

Author: Sara LaJeunesse
Source: Penn State
Contact: Sara LaJeunesse – Penn State
Image: Image is in public domain

Original research: Free access.
“The effects of reduced nicotine cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: a randomized trial double-blind” by Jonathan Foulds et al. PLOS ONE


Summary

The effects of reduced nicotine cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: a randomized trial in double blind

Background

The United States Food and Drug Administration and the New Zealand government have proposed reducing the nicotine content of cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders.

Methods

In a randomized, parallel-group controlled trial conducted at two sites in the United States (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA), 188 adult smokers with current (n=118) or lifelong anxiety (n=70) or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned (1:1) to smoke either usual nicotine strength research cigarettes (UNC) (11.6 mg nicotine/cigarette), a research of reduced nicotine (RNC) cigarettes where the nicotine content per cigarette was gradually reduced to 0.2 mg in five steps over 18 weeks. Participants were then given the choice of receiving help to quit smoking, receiving free research cigarettes, or resuming use of their own brand of cigarettes for a 12-week follow-up period. The primary outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior, dependence, and severity of psychiatric symptoms. The pre-recorded primary endpoint was plasma cotinine.

Results

A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to lower nicotine cigarettes, compared to smokers in the UNC group, at the last randomized visit, the RNC group had significantly lower plasma cotinine (metabolite of nicotine): difference between groups, – 175.7, 95% CI [-218.3, -133.1] ng/ml. Urinary NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon monoxide, cigarette consumption and cigarette dependence were also significantly lower in the RNC group than in the UNC group. No differences between the groups were found on a range of other biomarkers (eg, 8-isoprostanes) or health indicators (eg, blood pressure), or on 5 different psychiatric questionnaires, including Kessler K6 measure of psychological distress. At the end of the next 12-week treatment choice phase, people randomized to the RNC group were more likely to have quit smoking, based on the original intention-to-treat sample, n = 188 (18 .1% RNC versus 4.3% UNC, p=0.004).

Conclusion

Reducing the nicotine content of cigarettes to very low levels reduces certain toxicant exposures and cigarette dependence and increases smoking cessation in smokers with mood and/or anxiety disorders , without worsening mental health.

Trial registration

TRN: NCT01928758, recorded August 21, 2013.

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