Effects of very low nicotine cigarettes, e-cigarettes, and nicotine patches on daily own-cigarette abstinence in a randomized controlled switching trial.

Abstract

This research investigated the extent to which three nicotine products promote day-level cigarette substitution during a 1-week switch attempt METHODS: Adults who smoked daily but were not motivated to quit were randomized to 4 weeks using: 1) very low nicotine cigarettes (VLNCs), 2) e-cigarettes, or 3) no product. During two separate switch weeks, participants were instructed to abstain from their own cigarettes and switch to using their study product (if assigned one). Participants were also assigned to use active nicotine patches during one switch week and placebo patches during the other. Nightly smartphone surveys assessed use of participants' own-brand cigarettes. Average marginal effects from a logistic regression model characterized effects of trial design variables on day-level own-cigarette abstinence. Participants (N = 196) recorded 4998 evening reports. Switch weeks were associated with an average marginal increase in abstinence rate by 27.9 percentage points (p < .001). The switch week effect was significantly larger in the VLNC (35.9 percentage points), and e-cigarette (31.2) groups compared to the no product group (16.4; ps < .05). Use of active patches during the first switch week increased abstinence by 6.9 percentage points on average (p = .010), but use of active patches during the second switch week decreased abstinence probability by 9.6 percentage points (p = .032, difference p = .010) CONCLUSIONS: VLNCs and e-cigarettes meaningfully and equivalently increase the probability of day-level abstinence from one's own cigarettes. Transdermal nicotine promotes cigarette substitution, but only when provided early in the switching process.