E-cigarette use to reduce smoking may not increase nicotine addiction


HERSHEY, Pa. — E-cigarettes have captured media and consumer attention for their addictive nature, variety of flavors, and increased use among teens, prompting regulatory scrutiny and policy. A Penn State College of Medicine study suggests that these devices can help people reduce their addiction to combustible cigarettes – which contain a range of harmful chemicals called toxins – without increasing their overall addiction to nicotine.

Smoking is one of the leading causes of death in the United States, and despite interest in cessation and the availability of FDA-approved cessation methods, smokers still struggle to quit. Some public health experts have offered e-cigarettes as a “lower-risk” alternative to cigarettes for those not interested or able to quit smoking, citing reports like that from the National Academies of Sciences, the engineering and medicine, which found that substituting e-cigarettes for combustible cigarettes reduced users’ exposure to carcinogens and other harmful toxicants.

Jessica Yingst, assistant professor of public health sciences and researcher at the Penn State Cancer Institute, and her colleagues at the Penn State Center for Research on Tobacco and Health are studying e-cigarettes and determining whether they can help nicotine users quit smoking. smoke or reduce their exposure to the harmful toxic substances found in cigarettes. Their latest study addressed a common question – whether initiating e-cigarette use to reduce smoking could potentially increase nicotine addiction.

“Research on this topic is conflicting because in previous studies, participants used their own devices with unknown nicotine delivery profiles,” Yingst said. “Our study used devices with known nicotine delivery profiles, which allowed us to effectively compare how different levels of nicotine in a device might affect a user’s nicotine dependence and ability. to reduce cigarette consumption.

The researchers recruited 520 participants who were interested in reducing their cigarette consumption but had no plans or interest in quitting smoking and asked them to reduce their cigarette consumption over the six-month study period. Participants were randomly given an e-cigarette delivering 36, 8 or 0 mg/mL of nicotine, or a cigarette substitute that did not contain tobacco, to help them in their efforts to reduce their cigarette consumption.

Participants self-reported their dependence on cigarettes and e-cigarettes at one, three, and six months using validated measures of addiction, including a questionnaire developed by Penn State that ranges from 0 (not addicted at all) to 20 (very dependent). Urine samples were also collected throughout the study to measure cotinine, a biomarker of nicotine exposure.

At six months, all participants in the e-cigarette groups reported a significant decrease in cigarette smoking, with those in the 36 mg/mL group smoking the fewest cigarettes per day. Those in the e-cigarette groups reported significantly lower dependence on the Penn State Cigarette Addiction Index than those in the cigarette substitute group.

Participants also reported their e-cigarette addiction using the Penn State E-Cigarette Dependence Index. E-cigarette addiction did not change significantly throughout the study, with the exception of participants in the 36 mg/mL group who saw a significant increase in addiction over the course of the study. but still much lower compared to cigarette addiction. Urinary cotinine levels remained constant across all groups throughout the study, suggesting that there was no increase in overall nicotine exposure during the study. . The results were published in the journal Nicotine and Tobacco Research.

“Our results suggest that using e-cigarettes or a cigarette substitute to reduce cigarette smoking may result in reduced self-reported cigarette smoking and dependence,” said Yingst, who leads the doctoral program. in public health from the College of Medicine. “Importantly, high-strength e-cigarette use did not increase overall nicotine dependence and was associated with a greater reduction in smoking compared to the cigarette substitute.”

Although it has been hypothesized that e-cigarette use may increase overall nicotine addiction, the research team said their study found that initiation of e-cigarette use to reduce cigarette consumption resulted in reduced cigarette addiction and low e-cigarette addiction. In the future, they will assess the health effects of completely switching from cigarettes to e-cigarettes.

Xi Wang and Jonathan Foulds of Penn State College of Medicine; Alexa Lopez of the University of Wisconsin-Milwaukee; Alison Breland, Andrew Barnes, Megan Underwood and Melanie Crabtree from Virginia Commonwealth University; Eric Soule of the College of Health and Human Performance at Eastern Carolina University; and Joanna Cohen of the Johns Hopkins Bloomberg School of Public Health also contributed to this research. Foulds has performed paid consulting for pharmaceutical companies involved in the manufacture of anti-smoking drugs (eg, Pfizer, GlaxoSmithKline, Johnson and Johnson); and acted as an expert witness filed and indemnified on behalf of the plaintiffs suing the cigarette companies. Other author disclosures can be read in the published manuscript.

This research was supported by the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the United States Food and Drug Administration (grant numbers P50DA036105 and U54DA036105). Data collection was supported by the Penn State Clinical and Translational Science Institute (grant number UL1TR002014) and the C. Kenneth and Dianne Wright Center for Clinical and Translational Research at Virginia Commonwealth University (grant number UL1TR002649) through from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is the sole responsibility of the authors and does not necessarily represent the official views of the sponsors.

Read the full manuscript at this link.


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