Flavored Vape Use Cut Cigarette Smoking in High-Risk Adults

TOPLINE:
E-cigarettes in preferred flavors (especially fruity and sweet) combined with very low nicotine content (VLNC) cigarettes reduce smoking behaviors in adults with psychiatric conditions or lower education levels, who are at the greatest risk for smoking-related harm.
METHODOLOGY:
Researchers hypothesized that cigarettes with VLNC used in combination with vapes that were fruity or sweet-flavored would result in the greatest reductions in smoking levels.
Three randomized clinical trials were conducted over 16 weeks at three sites in the United States between 2020 and 2023 to assess the smoking behaviors in high-risk adults using VLNC cigarettes.
326 adults (mean age, 40.09 years; 74.5% women) with affective disorder or substance use disorder or who had a high school education or less were included; all smoked at least five cigarettes a day and were not planning to quit in the following 30 days.
The participants were randomly assigned to one of the four groups: A control group using normal nicotine content (NNC) cigarettes (n = 67); cigarettes with 0.4 mg nicotine, or VLNC cigarettes (n = 66); VLNC cigarettes plus tobacco-flavored e-cigarettes with 5% nicotine by weight (n = 57); or VLNC cigarettes plus e-cigarettes with flavors like cucumber or mango and with 5% nicotine by weight (n = 70).
The primary outcome was the mean total cigarettes smoked per day at week 16, and the secondary outcomes were tobacco-related biomarkers and smoking abstinence.
TAKEAWAY:
Participants using VLNC cigarettes plus preferred flavor e-cigarettes smoked significantly fewer cigarettes per day than those using NNC cigarettes (adjusted mean difference [AMD], −14.91; 95% CI, −18.49 to −11.33; P < .001).
The decrease in cigarettes per day was greater for participants using VLNC cigarettes plus preferred flavor e-cigarettes than those using VLNC cigarettes (AMD, −6.70; P < .001) or the VLNC cigarettes plus e-cigarettes with tobacco flavor (AMD, −4.13; P = .02).
The three most frequently preferred flavors were mango (24.9%), fruit medley (19.6%), and classic menthol (12.2%).
Levels of the tobacco-specific carcinogen total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol were significantly lower in the VLNC cigarettes plus preferred flavor e-cigarettes than in the NNC cigarettes (P < .001), VLNC cigarettes (P = .03), and VLNC cigarettes plus e-cigarettes with tobacco flavor (P = .04).
IN PRACTICE:
“Ideally, a well-regulated marketplace with strong enforcement would allow adult access while preventing youth access. Whether that balance is achievable in the US marketplace remains unclear, but new evidence such as that reported here and elsewhere provides a reason to continue exploring that possibility and suggests that doing so can enhance the overall effect of a nicotine product standard on cigarette smoking should the FDA [US Food and Drug Administration] move forward with that policy,” the authors wrote.
SOURCE:
The study was led by Stephen T. Higgins, PhD, of the University of Vermont in Burlington, Vermont, and was published online on September 6, 2024, in JAMA Network Open.
LIMITATIONS:
The sample size in this study was smaller than planned due to the COVID-19 pandemic. The 20% dropout rate may also have introduced bias. Since the study duration was limited to 16 weeks, the effects of long-term exposure were not explored.
DISCLOSURES:
This study was supported by grants from the Tobacco Centers of Regulatory Science and the Centers of Biomedical Research Excellence, and other sources. The National Institute on Drug Abuse provided study cigarettes; e-cigarettes were purchased from JUUL Labs. Some authors reported receiving research grants from various organizations. No other conflicts of interest were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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