Brown University, Providence, RI, USA.
University of Vermont, Burlington, VT, USA.
Nicotine Tob Res. 2022 Nov 12;24(12):1959-1967. doi: 10.1093/ntr/ntac145.
Regulators are considering reducing the nicotine content in cigarettes to a minimally addictive level. This could particularly benefit smokers from populations vulnerable to heavy smoking and difficulties quitting. We assessed predictors of adherence among adults from vulnerable populations assigned to use very low nicotine content cigarettes (VLNCs) in randomized clinical trials, to identify characteristics of those who require additional assistance if a nicotine reduction policy were implemented.
Data came from three populations of vulnerable adult smokers assigned to use VLNC cigarettes (0.4 mg/g nicotine) during 12-week randomized controlled trials (n = 286): Socioeconomically disadvantaged women of reproductive age, opioid-maintained adults, and adults with affective disorders. Logistic and linear regressions modeled predictors of adherence based on changes in cotinine at week-6 and week-12 assessments relative to baseline, and as a 90% reduction in cotinine relative to baseline (full adherence: yes/no). Predictors included satisfaction with study cigarettes, craving, nicotine dependence severity, withdrawal, population membership, baseline affective-disorder symptoms, and sociodemographic characteristics.
Dependence severity was negatively associated with both adherence measures at week 6 (p < .01), whereas increased satisfaction with study cigarettes and age were positively associated with both measures at weeks 6 and 12 (p < .01). Opioid-maintained adults exhibited reduced adherence and were less likely to reach full adherence at week 12 compared to disadvantaged women (p = .02).
Factors associated with VLNC adherence in vulnerable populations are similar to those in the general population of smokers. Furthermore, studies are indicated investigating nicotine supplements (e.g., e-cigarettes, NRT) to support highly dependent adults faced with using VLNCs.
This study identified factors predicting difficulty maintaining adherence to a regimen of very low nicotine content cigarettes (VLNC) among adults from vulnerable populations. Findings suggested that factors predicting difficulty maintaining adherence (greater nicotine dependence and low satisfaction with study-provided VLNC) were common across vulnerable smokers and the general population of adults who smoke. Furthermore, research should investigate alternatives to support highly dependent adults, such as pairing VLNC with supplemental, noncombusted nicotine. Some vulnerable populations (e.g., opioid-maintained adults) may be especially in need of supplemental, noncombusted nicotine.
监管机构正在考虑将香烟中的尼古丁含量降低到最低成瘾水平。这对于易受吸烟影响且难以戒烟的弱势人群尤其有益。我们评估了在随机临床试验中被分配使用极低尼古丁含量香烟（VLNCs）的弱势人群中成年人的依从性预测因素，以确定如果实施尼古丁减少政策，那些需要额外帮助的人的特征。
数据来自三个脆弱成年吸烟者群体，他们在 12 周的随机对照试验中被分配使用 VLNC 香烟（尼古丁含量 0.4mg/g）（n=286）：社会经济地位低下的育龄妇女、阿片类药物维持的成年人和有情感障碍的成年人。基于第 6 周和第 12 周评估相对于基线的可替宁变化以及相对于基线的 90%可替宁减少，对依从性的预测因素进行了逻辑和线性回归建模（完全依从：是/否）。预测因素包括对研究香烟的满意度、渴望、尼古丁依赖严重程度、戒断、人群成员、基线情感障碍症状和社会人口统计学特征。
依赖严重程度与第 6 周的两种依从性测量值呈负相关（p <.01），而对研究香烟的满意度增加和年龄与第 6 周和第 12 周的两种测量值呈正相关（p <.01）。与处境不利的妇女相比，阿片类药物维持的成年人的依从性降低，在第 12 周达到完全依从的可能性较小（p=.02）。
与一般吸烟人群相比，与 VLNC 依从性相关的因素在弱势人群中相似。此外，还需要进行研究，以调查尼古丁补充剂（例如电子烟、NRT），以支持面临使用 VLNC 的高度依赖成年人。
本研究确定了弱势人群中维持极低尼古丁含量香烟（VLNC）治疗方案依从性的预测因素。研究结果表明，预测维持依从性困难的因素（更强的尼古丁依赖和对研究提供的 VLNC 的低满意度）在脆弱吸烟者和一般吸烟人群中是共同的。此外，研究应调查替代方案，以支持高度依赖的成年人，例如将 VLNC 与补充、非燃烧尼古丁配对。一些弱势人群（例如阿片类药物维持的成年人）可能特别需要补充、非燃烧尼古丁。
