title: Evaluation of a reduced nicotine product standard: Moderating effects of and impact on cannabis use.
abstract: The Family Smoking Prevention and Tobacco Control Act authorized the FDA to reduce the nicotine content in cigarettes. Research is needed to guide proposed regulations, including evaluation of consequences to public health. This study evaluated how a reduced nicotine product standard might be moderated by and impact cannabis use.
  
  
  
  Secondary analysis of a controlled clinical trial examining the effects of nicotine content in cigarettes in adult daily smokers. Linear regression assessed whether baseline cannabis use moderated behavioral, subjective, or physiological effects of smoking very low nicotine content (VLNC) versus normal nicotine content (NNC) cigarettes. Repeated measures analysis of associations between nicotine condition and prevalence and frequency of cannabis use was completed using generalized estimating equations (GEE).
  
  
  
  Cannabis use did not moderate most of the following effects of VLNC cigarettes: Among cannabis users and non-users, smokers randomized to VLNC cigarettes reported lower nicotine dependence, cigarettes per day, biomarkers of nicotine exposure, and craving compared to smokers randomized to NNC cigarettes. Non-cannabis using smokers randomized to VLNC cigarettes also reported lower smoking dependence motives and had lower tobacco-specific nitrosamine exposure and total puff volume versus smokers randomized to NNC cigarettes. For cannabis users, smokers randomized to VLNC cigarettes reported decreased positive affect. VLNC cigarette use did not impact the prevalence or frequency of cannabis use.
  
  
  
  Findings provide evidence that nicotine reduction in cigarettes could have beneficial effects on cigarette smoking regardless of cannabis use. Results suggest that transitioning to VLNC cigarettes is unlikely to alter current rates of cannabis use.
authors: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA. Electronic address: lauren.pacek@duke.edu.
authors: Lauren R
authors: LR
authors: Pacek
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
authors: Ryan
authors: R
authors: Vandrey
authors: Centre for Addiction and Mental Health, Toronto, ON, Canada.
authors: Sarah S
authors: SS
authors: Dermody
authors: Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA.
authors: Rachel L
authors: RL
authors: Denlinger-Apte
authors: Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, MN, 55812, USA.
authors: Andrine
authors: A
authors: Lemieux
authors: Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA.
authors: Jennifer W
authors: JW
authors: Tidey
authors: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA.
authors: F Joseph
authors: FJ
authors: McClernon
authors: Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA.
authors: Ananta S
authors: AS
authors: Bangdiwala
authors: Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa FL, 33612, USA.
authors: David J
authors: DJ
authors: Drobes
authors: Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, MN, 55812, USA.
authors: Mustafa
authors: M
authors: al'Absi
authors: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors: Andrew A
authors: AA
authors: Strasser
authors: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA.
authors: Joseph S
authors: JS
authors: Koopmeiners
authors: Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN, 55455, USA.
authors: Dorothy K
authors: DK
authors: Hatsukami
authors: Department of Psychology, University of Pittsburgh, Pittsburgh PA, 15260, USA.
authors: Eric C
authors: EC
authors: Donny
mesh_terms: D000328:Adult; D015415:Biomarkers; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000008:administration & dosage; D015995:Prevalence; D011634:Public Health; D016540:Smoking Cessation / Q000379:methods*; D062789:Tobacco Products; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D009538:Nicotine
keywords: Cannabis; Cigarette; Co-use; Comorbidity; Marijuana; Nicotine; Smoking