Cigarettes with reduced nicotine content lead to less smoking in anxious and depressed smokers
Abstract: Reducing nicotine levels to non-addictive levels reduces smoking without exacerbating symptoms of depression and anxiety in people suffering from mental health disorders.
Source: Penn State
Reducing the amount of nicotine in cigarettes to non-addictive levels can reduce smoking without worsening mental health in smokers with mood or anxiety disorders, according to Penn State College of Medicine and Harvard Medical School researchers.
They said that reducing the nicotine content of cigarettes can also reduce addiction, reduce exposure to toxic substances and increase smokers’ chances of quitting.
Tobacco remains the leading preventable cause of premature death and disease in the United States. Recent proposals from the US Food and Drug Administration and the New Zealand government seek to limit the amount of nicotine in cigarettes to minimally addictive levels.
Previous research has shown that nicotine reductions can help smokers quit, but there is little evidence to show whether these policies can negatively impact smokers with current or previous affective disorders such as depression and anxiety disorders — which affect an estimated 38% of cigarette smokers in USA.
According to Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health, smokers with psychological problems are more likely to have severe nicotine withdrawal symptoms and less successful at quitting.
He also said there was speculation that reducing nicotine content to very low levels could worsen psychiatric symptoms in smokers with mental health problems and lead to more intense smoking and increased exposure to toxins or harmful chemicals.
Researchers studied 188 smokers with a history or current history of a mood or anxiety disorder and no plans to quit.
Volunteer participants were randomly assigned to a group that received either research cigarettes containing the usual amount of nicotine (11.6 mg nicotine/cigarette) or a progressively reduced amount of nicotine for an additional 18 weeks (the final amount was 0.2 mg nicotine/cigarette). .
At the beginning and end of the study, scientists measured levels of cotinine, nicotine metabolites, levels of harmful chemicals, indices of cigarette addiction and various measures of mental health.
The researchers observed no statistically significant differences in measures of mental health between the two groups at the end of the study.
The team used the Kessler Psychological Distress Scale, a six-point self-report assessment where participants reported on a 5-point scale the degree to which they experienced feelings or emotions such as “nervous,” “hopeless,” or “so depressed that nothing can cheer them up.” ” The results are obtained by adding up the points for the six experiences.
Participants in the reduced nicotine group scored an average of 5.3 at the start of the study and finished with an average score of 4.6, while participants in the regular nicotine group scored a 6.1 at the start of the study and finished around 4.9.
“These findings are important because we want to understand the effect these policies would have on smokers with anxiety or depressive disorders,” said Foulds, a Penn State Cancer Institute researcher.
“Our data showed that there was no significant difference in measures of mental health between the groups, suggesting that the reduced amounts of nicotine in cigarettes may not have negative psychological effects in this population.”
Similar to what previous studies have reported, Foulds and team found that groups in the reduced-nicotine group absorbed less nicotine and ingested lower levels of harmful carcinogens such as the biomarker 4-(methylnitrosamino)-1-(3-priidyl)- 1-butanol), better known as NNAL. This group also smoked fewer cigarettes and reported lower levels of nicotine dependence by the end of the randomized phase of the trial.
The results were published in PLOS ONE today, November 2.
Unique to this study, participants in both groups were also given the choice to “choose their treatment”, after the 18-week period. They could return to using their own cigarettes, continue smoking research cigarettes, or try to quit.
Of the 188 study participants, those randomized to reduced-nicotine cigarettes were more likely to quit smoking 12 weeks later (18.1%), compared to those in the control (regular nicotine) group (4.3%). .
“We believe this is the first randomized trial to show that smokers who used very low nicotine cigarettes were significantly more likely to quit smoking (by biochemical screening) three months after the trial ended,” Foulds said.
“Our results suggest that these policies are likely to result in reduced absorption of nicotine from cigarettes without worsening the mental health of smokers with mood or anxiety disorders,” said Dr. Eden Evins, Cox Family Professor of Psychiatry at Harvard Medical School. “They also suggest that with the right support and resources, smokers with mood and anxiety disorders could successfully quit smoking as a result of these policies.”
For more information on nicotine, smoking and health studies at the Penn State Center for Tobacco and Health Research, visit https://research.med.psu.edu/smoking/#participants.
Susan Veldheer, Ahmad Hameed, Sophia Allen, Jessica Yingst, Erin Hammett, Jennifer Modesto, Nicolle Krebs, Courtney Lester, Neil Trushin, Lisa Reinhart, Emily Wasserman, Junija Zhu, Jason Liao, Joshua Muscat and John Richie from Penn State College of Medicine ; Shari Hrabovsky of Penn State’s Ross and Carol Nese College of Nursing; and Gladys Pachas, Corinne Cather, Nour Azzouz, and A. Edin Evins of Harvard Medical School also contributed to this research. Foulds and Evins provided paid consulting services to pharmaceutical companies involved in the production of smoking cessation drugs. Other conflicts of interest of the authors are listed in the manuscript.
Financing: This research was supported by the National Institutes of Health through the National Institute on Drug Abuse of the National Institutes of Health (award P50DA036107) and the National Center for Advanced Translational Sciences through the Penn State Clinical and Translational Science Institute (award UL1 TR000127). The research was also supported by the US Food and Drug Administration’s Center for Tobacco Products. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.
About this nicotine addiction and mental health research news
Original research: Open access.
“Effects of nicotine-reduced cigarettes on biomarkers of nicotine and toxic exposure, smoking behavior, and psychiatric symptoms in smokers with mood or anxiety disorders: a double-blind, randomized study” by Jonathan Foulds et al. VERY ONE
Effects of nicotine-reduced cigarettes on biomarkers of nicotine and toxic exposure, smoking behavior, and psychiatric symptoms in smokers with mood or anxiety disorders: a double-blind, randomized study
The US Food and Drug Administration and the New Zealand government have proposed reducing the nicotine content of cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders.
In a randomized controlled parallel group trial conducted at two sites in the USA (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with current (n = 118) or lifetime (n = 70) anxiety or unipolar mood disorder, who did not plan to quit within the next 6 months, were randomly assigned (1:1) to smoke either regular nicotine (UNC) cigarettes (11.6 mg nicotine/cigarette) or reduced nicotine study (RNC) . cigarettes where the nicotine content per cigarette was gradually reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice of either receiving help to quit smoking, receiving free research cigarettes, or continuing to use their own brand of cigarettes during the 12-week follow-up period. Main outcomes were biomarkers of exposure to nicotine and toxins, smoking behavior, and dependence and severity of psychiatric symptoms. The pre-registered primary outcome was plasma cotinine.
A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to the lowest nicotine cigarettes, compared with smokers in the UNC group, the RNC group had significantly lower plasma cotinine (nicotine metabolite) at the last randomized visit: between-group difference, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urinary NNAL (a metabolite of NNK, a lung carcinogen), exhaled carbon monoxide, cigarette consumption, and cigarette dependence were also significantly lower in the RNC group than in the UNC group. No group differences were found in a number of other biomarkers (eg, 8-isoprostanes) or health indicators (eg, blood pressure), nor in 5 different psychiatric questionnaires, including the Kessler K6 measure of psychological distress. At the end of the next 12-week treatment choice phase, those randomized to the RNC group were more likely to quit smoking, based on the initial intention-to-treat sample, n = 188 (18.1% RNC vs 4.3% UNC, p = 0.004).
Reducing the nicotine content of cigarettes to very low levels reduces exposure to some toxins and addiction to cigarettes and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health.
THORN: NCT01928758registered on August 21, 2013.