Summary: Reducing nicotine levels to non-addictive levels reduces smoking without worsening symptoms of depression and anxiety for those with mental health disorders.
Font: State of Pennsylvania
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 researchers at Penn State Medical School and Harvard Medical School .
They said that reducing the nicotine content of cigarettes could also decrease addiction, reduce exposure to toxic substances and increase a smoker’s chances of quitting.
Tobacco remains the leading preventable cause of premature death and disease in the United States. Recent proposals by 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 indicates that reducing nicotine content could help smokers quit, but there is little evidence to show whether these policies could negatively affect smokers with current or past affective disorders, such as depression and anxiety disorders, that affect about 38% of US cigarette smokers
According to Jonathan Foulds, a professor of public health sciences and of psychiatry and behavioral health, smokers with mental health problems are more likely to have severe nicotine withdrawal symptoms and less successful quitting.
He also said there is speculation that reducing nicotine content to very low levels could worsen psychiatric symptoms in smokers with mental health problems and lead to increased tobacco use and increased exposure to toxic substances or harmful chemicals.
The researchers studied 188 smokers with a history of or current mood or anxiety disorder and no plans to quit.
Voluntary participants were randomly assigned to a group that received investigational cigarettes containing the usual amount of nicotine (11.6 mg nicotine/cigarette) or a progressively reduced amount of nicotine for an additional 18 weeks (final amount was 0.2 mg nicotine/cigarette). ).
At the beginning and end of the study, the researchers measured levels of cotinine, a metabolite of nicotine, levels of harmful chemicals, rates of cigarette dependence and various measures of mental health.
The researchers found no statistically significant differences in mental health measures between the two groups at the end of the study.
The team used the Kessler Psychological Distress Scale, a six-item self-report assessment in which participants reported on a 5-point scale the degree to which they experienced feelings or emotions such as “nervous,” “hopeless,” or “so nervous.” depressed that nothing could. encourage them.” Scores are developed by adding the points from the six experiences.
Participants in the reduced nicotine content group scored an average of 5.3 at the start of the study and ended with an average score of 4.6, while participants in the regular nicotine content group scored 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 researcher at the Penn State Cancer Institute.
“Our data showed that there was no significant difference in mental health measures between groups, suggesting that lower nicotine cigarettes may not have adverse psychological effects in this population.”
Similar to previous studies, Foulds and his team found that groups in the reduced nicotine content group absorbed lower amounts of nicotine and ingested lower levels of harmful carcinogens such as the biomarker 4-(methylnitrosamine)-1 -(3-pyridyl)-1-butanol), more commonly known as NNAL. That group also smoked fewer cigarettes and reported lower levels of nicotine addiction at 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 option to “choose your treatment” after the 18-week period. They could go back to using their own cigarettes, continue to smoke the research cigarettes, or try to quit.
Of the 188 study participants, those randomized to reduced-nicotine cigarettes were more likely to have quit 12 weeks later (18.1%), compared with those in the control group (usual nicotine content ) (4.3%).
“We believe this is the first randomized trial to find that smokers using very low-nicotine cigarettes were significantly more likely to quit (with biochemical verification) three months after the end of the trial,” Foulds said.
“Our results suggest that these policies will likely result in reduced absorption of nicotine from cigarettes without worsening the mental health of smokers with mood or anxiety disorders,” said Dr. Eden Evins, professor of psychiatry at the Cox family at Harvard Medical School. “They also suggest that with the right support and resources, smokers with mood and anxiety disorders may be able to quit successfully as a result of these policies.”
For more information on nicotine, smoking, and health studies at the Penn State Center for Research on Tobacco and Health, visit https://research.med.psu.edu/Smoking/#participants.
See also
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 of the University of California College of Medicine. PennState; Shari Hrabovsky of Penn State 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 have done paid consulting for pharmaceutical companies involved in the production of smoking cessation drugs. Other conflicts of interest of the author are indicated in the manuscript.
Money: This research was supported by the National Institutes of Health through the National Institute on Drug Abuse at the National Institutes of Health (award P50DA036107) and the National Center for Advancing Translational Sciences through the Institute for Clinical and Translational Sciences. from Penn State (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 research news on nicotine addiction and mental health
Author: Sara LaJeunesse
Font: State of Pennsylvania
Contact: Sara La Jeunesse – Penn State
Image: The image is in the public domain.
original research: Open access.
“The effects of reduced-nicotine cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior, and psychiatric symptoms in smokers with mood or anxiety disorders: a double-blind randomized trial.” by Jonathan Foulds et al. PLUS ONE
Summary
The effects of reduced-nicotine cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior, and psychiatric symptoms in smokers with mood or anxiety disorders: a double-blind randomized trial.
Background
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.
Methods
In a randomized controlled parallel group trial conducted at two sites in the US (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with current (n = 118) or current anxiety (n = 70) or unipolar mood disorder, with no plans to quit within the next 6 months, were randomly assigned (1:1) to smoke investigational cigarettes with usual nicotine content (UNC) (11, 6 mg nicotine/cigarette) or investigational reduced nicotine content (RNC) cigarettes in which the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice of receiving assistance to quit smoking, receiving free research cigarettes, or going back to using their own brand of cigarettes during a 12-week follow-up period. The main outcomes were biomarkers of exposure to nicotine and toxic substances, smoking behavior and dependence, and severity of psychiatric symptoms. The previously recorded primary outcome was plasma cotinine.
Results
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 cigarettes with the lowest nicotine content, compared to smokers in the UNC group, at the last random visit, the RNC group had significantly lower plasma cotinine (nicotine metabolite): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urinary NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon monoxide, cigarette smoking, and cigarette dependence were also significantly lower in the RNC group than in the UNC group. No differences were found between groups on a range of other biomarkers (eg, 8-isoprostanes) or health indicators (eg, blood pressure), or on 5 different psychiatric questionnaires, including a measure of psychological distress Kessler K6. At the end of the subsequent 12-week treatment election phase, those randomized to the RNC group were more likely to have quit smoking, based on the initial intention-to-treat sample, n = 188 (18.1% RNC v 4 .3% UNC, p = 0.004).
conclusion
Reducing the nicotine content of cigarettes to very low levels reduces some toxic exposures and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health.
test record
NRT: NCT01928758registered on August 21, 2013.
