E-cigarettes use in preferred flavors increases effect of nicotine-reduction, suggests JAMA study

A recent study suggests that allowing participants to use their preferred e-cigarette flavors, including fruity and sweet options, led to greater reductions in smoking compared to limiting flavors to traditional tobacco. This study published in the Journal of American Medical Association compared smoking reduction strategies that has raised concerns about the potential impact of restricting popular e-cigarette flavors on efforts to decrease smoking among adults.

The trials was conducted at the University of Vermont, Brown University, and Johns Hopkins University which included a total of 326 daily smokers from high-risk populations, who were the adults with affective disorders (mental illness), those with opioid use disorder (substance use), and females of reproductive age with lower educational levels. These individuals were not planning to quit smoking in the next 30 days which made them a critical group for understanding the effectiveness of smoking reduction strategies.

These participants were divided into 4 groups based on their smoking interventions as normal nicotine content (NNC) cigarettes, very low nicotine content (VLNC) cigarettes, VLNC cigarettes combined with e-cigarettes in tobacco flavor (VLNC + TF) and VLNC cigarettes combined with e-cigarettes in preferred flavors, such as fruity and sweet (VLNC + PF).

After 16 weeks, all groups using VLNC cigarettes showed a significant reduction in the number of cigarettes smoked per day (CPD) when compared to the smoking regular nicotine cigarettes. However, the most significant reduction was observed in participants who could use their preferred e-cigarette flavors (VLNC + PF). This group smoked an average of 7.63 cigarettes per day which is significantly lower than the 14.32 CPD in the VLNC-only group and 11.76 CPD in the VLNC + TF group.

Tobacco-related carcinogen levels, measured using NNAL, were also lowest in the VLNC + PF group in addition to the reduced smoking frequency. This suggests that not only did preferred flavors help the participants smoke fewer cigarettes, but they also led to a greater reduction in harmful tobacco exposure.

The findings of this study highlighted the importance of flavor preferences in supporting smoking reduction efforts among high-risk adults. The participants using VLNC cigarettes combined with their chosen flavors were able to decrease smoking significantly more than the individuals limited to tobacco-flavored e-cigarettes. This reduction was particularly pronounced among adults with mental illness, substance use disorders, or lower educational levels, all groups more vulnerable to smoking-related health risks. Overall, E-cigarette flavors appear to play a crucial role in helping high-risk populations decrease their cigarette consumption, thereby lowering exposure to harmful tobacco toxins.

Source:

Higgins, S. T., Sigmon, S. C., Tidey, J. W., Heil, S. H., Gaalema, D. E., Lee, D. C., DeSarno, M. J., Klemperer, E. M., Menson, K. E., Cioe, P. A., Plucinski, S., Wiley, R. C., & Orr, E. (2024). Reduced Nicotine Cigarettes and E-Cigarettes in High-Risk Populations. In JAMA Network Open (Vol. 7, Issue 9, p. e2431731). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.31731