Higgins Stephen T, Heil Sarah H, Sigmon Stacey C, Tidey Jennifer W, Gaalema Diann E, Hughes John R, Stitzer Maxine L, Durand Hanna, Bunn Janice Y, Priest Jeff S, Arger Christopher A, Miller Mollie E, Bergeria Cecilia L, Davis Danielle R, Streck Joanna M, Reed Derek D, Skelly Joan M, Tursi Lauren
University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington.
Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island.
JAMA Psychiatry. 2017 Oct 1;74(10):1056-1064. doi: 10.1001/jamapsychiatry.2017.2355.
A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States.
To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content.
DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016.
After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions.
Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale.
Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η2 = 0.008; dose-by-time interaction, P = .002).
Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.
美国正在考虑一项国家政策，以降低香烟中的尼古丁含量，从而降低尼古丁成瘾的可能性。
研究患有精神疾病以及其他易患烟草成瘾症的吸烟者对尼古丁含量降低的香烟的反应。
设计、地点和参与者：在3个学术地点进行的一项多地点、双盲、参与者内评估，评估对尼古丁含量从低于假设成瘾阈值到代表商业香烟水平（0.4、2.3、5.2和15.8毫克/克烟草）的研究香烟的急性反应，纳入了来自以下3个易患人群的169名每日吸烟者：情感障碍患者（n = 56）或阿片类药物依赖者（n = 60）以及社会经济地位不利的女性（n = 53）。数据收集时间为2015年3月23日至2016年4月25日。
在短暂戒烟后，参与者在14次2至4小时的门诊就诊中接触不同尼古丁剂量的香烟。
使用同时选择测试、香烟购买任务（CPT）以及主观效应的验证测量指标（如明尼苏达尼古丁戒断量表）评估香烟的成瘾潜力。
在纳入分析的169名每日吸烟者中（120名女性[71.0%]和49名男性[29.0%]；平均[标准差]年龄为35.6[11.4]岁），降低香烟中的尼古丁含量降低了所有3个人群中吸烟的相对强化效应。在所有人群中，在同时选择测试中，0.4毫克/克剂量的选择显著少于15.8毫克/克剂量（平均[标准误]30%[0.04%]对70%[
