Higgins Stephen T, Erath Tyler G, DeSarno Michael, Reed Derek D, Gaalema Diann E, Sigmon Stacey C, Heil Sarah H, Tidey Jennifer W
Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America.
Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America.
Prev Med. 2022 Dec;165(Pt B):107206. doi: 10.1016/j.ypmed.2022.107206. Epub 2022 Aug 19.
We examined if the relative-reinforcing effects of smoking increase with greater cumulative vulnerability and whether cumulative vulnerability moderates response to reduced nicotine content cigarettes. Participants were 775 adults from randomized clinical trials evaluating research cigarettes differing in nicotine content (0.4, 2.4, 15.8 mg/g). Participants were categorized as having low (0-1), moderate (2-3), or high (≥4) cumulative vulnerability. Vulnerabilities included rural residence, opioid use disorder, affective disorder, low educational attainment, poverty, unemployment, and physical disability. We used the cigarette purchase task (CPT) to assess the relative-reinforcing effects of participants' usual-brand cigarettes at baseline and study cigarettes during the 12-week trial. The CPT is a behavioral-economic task wherein participants estimate likely smoking (demand) over 24 h under escalating cigarette price. Demand is characterized by two factors: Amplitude (demand volume at zero/minimal price) and Persistence (demand sensitivity to price). Greater cumulative vulnerability was associated with greater demand Amplitude (F[2709] = 16.04,p < .0001) and Persistence (F[2709] = 8.35,p = .0003) for usual-brand cigarettes. Demand Amplitude for study cigarettes increased with increasing cumulative vulnerability (F[2619] = 19.59, p < .001) and decreased with decreasing nicotine content ([4879] = 5.45, p < .001). The only evidence of moderation was on demand Persistence (F[8867] = 2.00,p = .04), with larger reductions at the 0.4 mg/g compared to 15.8 mg/g doses among participants with low compared to moderate or high cumulative vulnerability. The relative-reinforcing effects of smoking clearly increase with greater cumulative vulnerability. Reducing nicotine content would likely reduce demand Amplitude across cumulative-vulnerability levels but reductions in demand Persistence may be more limited among those with greater cumulative vulnerability.
我们研究了吸烟的相对强化作用是否会随着累积易感性的增加而增强，以及累积易感性是否会调节对尼古丁含量降低的香烟的反应。参与者是来自随机临床试验的775名成年人，这些试验评估了尼古丁含量不同（0.4、2.4、15.8毫克/克）的研究用香烟。参与者被分类为具有低（0 - 1）、中（2 - 3）或高（≥4）累积易感性。易感性包括农村居住、阿片类药物使用障碍、情感障碍、低教育程度、贫困、失业和身体残疾。我们使用香烟购买任务（CPT）在基线时评估参与者常用品牌香烟的相对强化作用，并在12周的试验期间评估研究用香烟的相对强化作用。CPT是一项行为经济学任务，参与者在香烟价格不断上涨的情况下估计24小时内可能的吸烟量（需求）。需求由两个因素表征：幅度（零/最低价格时的需求量）和持续性（需求对价格的敏感度）。更高的累积易感性与常用品牌香烟的更大需求幅度（F[2,709] = 16.04，p <.0001）和持续性（F[2,709] = 8.35，p =.0003）相关。研究用香烟的需求幅度随着累积易感性的增加而增加（F[2,619] = 19.59，p <.001），并随着尼古丁含量的降低而降低（F[4,879] = 5.45，p <.001）。调节作用的唯一证据在于需求持续性（F[8,867] = 2.00，p =.04），与15.8毫克/克剂量相比，在累积易感性低的参与者中，0.4毫克/克剂量下需求持续性的降低幅度更大，而累积易感性中等或高的参与者中降低幅度较小。吸烟的相对强化作用显然会随着累积易感性的增加而增强。降低尼古丁含量可能会降低所有累积易感性水平下的需求幅度，但对于累积易感性较高的人来说，需求持续性的降低可能更为有限。
