Preliminary evidence on cigarette nicotine reduction with concurrent access to an e-cigarette: Manipulating cigarette nicotine content, e-liquid nicotine content, and e-liquid flavor availability.

Introduction:
This text discusses a study on the impact of cigarette nicotine reduction and e-cigarette use on smoking behavior. The study aims to provide evidence for potential FDa policy scenarios regarding nicotine product regulation.

Key Points:

* The study recruited daily smokers from North Carolina and Pennsylvania and assigned them to different conditions in a 2 × 2 × 2 factorial design, receiving investigational cigarettes and an e-cigarette for 12 weeks.
* Cigarette nicotine content was very low (0.4 mg/g) or normal (15.8 mg/g), e-liquids had 0.3% or 1.8% freebase nicotine, and were available in tobacco flavors or tobacco, fruit, dessert, and mint flavors.
* The study found that randomization to VLNC cigarettes reduced self-reported cigarettes per day (CPD), but e-liquid nicotine content and flavor availability did not have significant effects.
* The effect of cigarette nicotine content was larger in the moderate vs. low nicotine e-liquid groups and in the all flavors versus tobacco flavors e-liquid groups.
* Biomarkers of smoke exposure at Week 12 did not differ across conditions, possibly due to variability in adherence to only using VLNC cigarettes.
* The study concludes that the extent to which cigarette nicotine reduction decreases smoking may depend on the reinforcing characteristics of alternative products, including e-cigarette nicotine contents and flavors.

Main Message:
The study offers preliminary evidence that reducing cigarette nicotine content may have varying effects on smoking behavior, depending on the availability and characteristics of alternative nicotine products, particularly e-cigarettes. This information can help inform FDa policy decisions regarding nicotine product regulation, emphasizing the need to consider the broader context of available alternatives.

White CM, Tessier KM, Koopmeiners JS, et al. Preliminary evidence on cigarette nicotine reduction with concurrent access to an e-cigarette: Manipulating cigarette nicotine content, e-liquid nicotine content, and e-liquid flavor availability. Preventive medicine. 2022;165:107213. doi:10.1016/j.ypmed.2022.107213