Increasing Quit Attempts by Transitioning to Very Low Nicotine Content Cigarettes Versus Reducing Number of Cigarettes Per Day: A Secondary Analysis of an Exploratory Randomized Trial

Elias M Klemperer, John R Hughes, Peter W Callas, Elias M Klemperer, John R Hughes, Peter W Callas

Abstract

Introduction: The Food and Drug Administration (FDA) has proposed reducing nicotine with very low nicotine content (VLNC) cigarettes. In contrast, reducing nicotine by reducing number of cigarettes per day (CPD) is common. Our prior findings demonstrate that VLNC cigarettes decreased dependence more and were more acceptable than reducing CPD. This secondary analysis explored which reduction strategy increased quit attempts (QA), self-efficacy, or intention to quit more.

Methods: This is a secondary analysis of 68 adult daily smokers not ready to quit randomized to smoke VLNC cigarettes versus reduce CPD over 5 weeks. All participants smoked study cigarettes with nicotine yield similar to most commercial cigarettes ad lib for 1 week (baseline). Participants were then randomized to gradually reduce to 70%, 35%, 15%, and 3% of baseline nicotine over 4 weeks by either (1) transitioning to lower nicotine VLNC cigarettes or (2) reducing the number of full nicotine CPD. All participants received nicotine patches to aid reduction. We assessed (1) QAs using nightly and weekly self-reports, (2) Velicer's Self-Efficacy to Quit measure weekly, and (3) the Intention-to-Quit Ladder nightly.

Results: More CPD (41%) than VLNC (17%) participants made any QA (odds ratio = 3.4, 95% confidence interval = 1.1, 10.5). There was no difference in QAs ≥24 h. Self-efficacy increased for VLNC but not CPD participants (interaction: F = 3.7, p < .01). The condition by time interaction for intention-to-quit was not significant.

Conclusions: Reducing number of CPD increased QAs more than reducing nicotine via switching to VLNC cigarettes. The lack of difference in longer QAs suggests replication tests are needed.

Implications: Reducing the frequency of smoking behavior (ie, CPD) could be a more effective strategy to increase QAs than reducing the magnitude of nicotine in each cigarette (ie, VLNC) per se.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

Figures

Figure 1.
Figure 1.
Condition predicts time to first any quit attempt. Censored = indication of end of follow-up for participants who dropped out of the trial. CPD = condition that reduced cigarettes per day (n = 32); QA = quit attempt; VLNC = condition that switched to very low nicotine content cigarettes (n = 36). During week 0, no VLNC participants and two CPD participants made any QA and no participants made a ≥24-h QA. Findings from sensitivity analyses including the two participants who made a QA during week 0 were similar to our primary findings.
Figure 2.
Figure 2.
Intention to quit and self-efficacy to quit. **p < .01 for post hoc between-condition t-test at week 4; CPD = condition that reduced cigarettes per day (n = 32); nic = nicotine; VLNC = condition that smoked low nicotine cigarettes (n = 36). The presented values are estimated marginal means from the multilevel model.

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