Reduced nicotine content cigarettes and use of alternative nicotine products: exploratory trial.
To compare the use of alternative nicotine products, smoking behavior and tobacco biomarker exposure in smokers unwilling to quit who were assigned randomly to normal nicotine content (NNC) cigarettes or very low nicotine content (VLNC) cigarettes.



Randomized, parallel-arm 8-week study with assignment to VLNC (VLNC 1, n = 53) or NNC (NNC, n = 27) with access to non-cigarette combusted and non-combusted tobacco/nicotine products or to VLNC with access to only non-combusted products (VLNC2, n = 56).



Clinics in Minnesota, USA.



Smokers uninterested in quitting smoking with a mean [± standard deviation (SD)] age of 44 (± 14) years and smoking 16 (± seven) cigarettes/day; 51% female, 72% white.



During the experimental period, the measures taken included: rate of alternative products used, amount of and abstinence from combusted tobacco used and tobacco exposure biomarkers.



There were higher rates of non-combusted alternative tobacco/nicotine product use in both VLNC conditions versus the NNC condition [rate ratio (RR) = 2.18, 95% confidence interval (CI) = 1.94, 2.46 and RR = 1.64, 95% CI = 1.46, 1.85, respectively] and in VLNC1 versus VLNC2 condition (RR = 1.33, 95% CI = 1.23, 1.44), accompanied by reduced biomarkers of exposure primarily in VLNC2 condition compared to NNC condition (Ps < 0.05). Fewer combusted products were smoked at almost all visits (Ps ≤ 0.02) and there were higher rates of abstinence for both VLNC conditions compared with the NNC condition (VLNC1 versus NNC: RR = 9.96, 95% CI = 5.01, 19.81; VLNC2 versus NNC: RR = 11.23, 95% CI = 5.74, 21.97).



The offer of, and instructions to use, reduced nicotine content cigarettes during an 8-week period led to greater use of alternative tobacco/nicotine products compared with continued use of normal nicotine cigarettes and also reductions in smoking rates.
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.|Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
Dorothy K
DK
Hatsukami
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.|Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Xianghua
X
Luo
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Laura
L
Dick
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Margarita
M
Kangkum
Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
Sharon S
SS
Allen
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Sharon E
SE
Murphy
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Stephen S
SS
Hecht
James Cancer Center, Ohio State University, Columbus, OH, USA.
Peter G
PG
Shields
Duluth Medical Research Institute, University of Minnesota Medical School, Duluth, MN, USA.
Mustafa
M
al'Absi
D000328:Adult; D015415:Biomarkers / Q000652:urine; D000073865:Cigarette Smoking / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000032:analysis* / Q000652:urine*; D062789:Tobacco Products / Q000032:analysis / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*
D015415:Biomarkers; D009538:Nicotine
Alternative nicotine delivery systems; electronic cigarettes; exposure biomarkers; medicinal nicotine; nicotine regulation; product standards; reduced nicotine content cigarettes; smokeless tobacco