一项关于鼻烟的随机临床试验，研究了完全替代与部分替代香烟对吸烟相关行为和暴露生物标志物的影响。
A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure.
机构信息
Department of Psychology, University of Wisconsin-Stevens Point, WI.
Masonic Comprehensive Cancer Center, University of Minnesota, Minneapolis, MN.
出版信息
Nicotine Tob Res. 2020 Apr 17;22(4):473-481. doi: 10.1093/ntr/ntz055.
INTRODUCTION
This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.
METHOD
US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; "use snus as you like with your cigarettes"), (2) complete substitution (CS; "avoid cigarettes"), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).
RESULTS
Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N'-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.
CONCLUSIONS
Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.
IMPLICATIONS
Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.
引言
这项为期 8 周的多地点随机对照试验研究了鼻烟使用的不同影响，包括：（1）使用鼻烟的习惯；（2）吸烟和吸烟相关措施；（3）暴露于烟草相关成分。
方法
美国成年每日吸烟者（150 人；43.3%为女性；平均年龄为 43.5 岁）来自明尼苏达州明尼阿波利斯市、俄亥俄州哥伦布市和科肖克顿市以及纽约州布法罗市。在进行了为期 1 周的鼻烟抽样阶段后，至少使用 7 袋鼻烟的参与者被随机分为三组：（1）部分替代组（PS；“像吸烟一样使用鼻烟，但要避免吸烟”）；（2）完全替代组（CS；“避免吸烟”）；（3）常规品牌香烟组（UB）。分析包括组间分析（例如，PS 与 CS 之间的比较），使用 Wilcoxon 秩和检验比较每日吸烟量和鼻烟袋数，以及线性混合模型（生物标志物）。
结果
与 PS 和 UB 组相比，被分配到 CS 组的吸烟者报告称每日吸烟量减少更多（p <.001），使用的鼻烟袋数更多（p =.02），无烟日更多（CS 中位数为 14.5，PS 和 UB 中位数为 0，p <.001）。此外，结果表明 CS 组的一氧化碳（p <.001）、总尼古丁当量（p =.02）和五种挥发性有机化合物中的四种（p <.01）随时间减少。只有 PS 组在试验结束时暴露于 N'-亚硝基降烟碱的量增加（p <.04）。试验结束时，所有组的菲四醇含量均增加（p =.02），但组间无差异。
结论
完全从香烟转换到鼻烟的指示导致吸烟量和有害成分暴露的最大减少。
意义
直接指示吸烟者完全切换到鼻烟，而不是随意使用（不指示避免吸烟），对于减少吸烟和随后暴露于有害成分是必要的。
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