Assessing the Effect of Nicotine Reduction on ENDS User's Addiction and Exposures
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 116
- Locations
- 1
- Primary Endpoint
- Plasma Nicotine Boost
Study Overview
Brief Summary
The rapid increase of electronic nicotine delivery systems (ENDS) use by young people in the US and their potential to harm health, cause addiction, and serve as a risk for cigarette smoking or dual-use is alarming. The epidemic of ENDS use among young people in the US has been associated with the rise in popularity of ENDS products that are very efficient in delivering high doses of nicotine to users. Therefore, the investigators propose to study the effects of nicotine reduction (NR) on young ENDS users as a potential regulatory strategy to reduce the addictiveness and use of ENDS. The proposed studies are directly responsive to research priories identified by the FDA and specified in this RFA under Addiction; studying the "Impact of changes in tobacco product characteristics (e.g. nicotine formulation) on dependence". This project aims to provide an overview of this project's rationale significance divided into 1) scientific rationale and regulatory implications; 2) the need to respond to the rising trend of ENDS use among young people in the US; 3) the importance of reducing the addictiveness of ENDS; 4) the strength of our clinical and analytical lab approach for regulatory purposes; and 5) the strengths and weaknesses in the rigor of prior research about NR for ENDS.
Detailed Description
The use of electronic nicotine delivery systems (ENDS or e-cigarettes) has reached epidemic levels among young people in the United States (US). ENDS emit toxic substances, including nicotine that irreversibly affects the developing brain and leads to dependence and increased risk of cigarette smoking initiation. Evidence indicates that young people using ENDS are likely to accelerate use and become nicotine dependent. Some of the most popular ENDS among youth (e.g. JUUL with 5% nicotine liquid) deliver in one cartridge a nicotine dose equal to an entire pack of cigarettes, and many users are unaware of this substantial exposure and the related risk of addiction. On the other hand, nicotine reduction (NR) has been considered by the US Food and Drug Administration (FDA) as an important strategy to limit the addictiveness and use of tobacco products.
Now that the FDA regulates ENDS under the "deeming rule", such a strategy can be considered for these emerging tobacco products. However, the investigators still lack evidence on the expected effects of a range of NR levels on ENDS users at different stages of use trajectory. Using clinical and analytical lab methods, the investigators plan to compare among 5% nicotine ENDS users the effect of partial (3%/2.4%) or total (nicotine-free, 0%) NR on users' dependence, satisfaction, clinical (e.g. BP, oximetry, lung functions, symptoms), puffing behavior, and exposure to toxicants. The investigators will recruit current ENDS users (n=120; 21-35 yrs), for a 2X2 within subject crossover lab study. The nicotine conditions (5%, 3%/2.4%) or (0%,5%) x 2 times (pre-post) are the within-subject factors.
Therefore, the study is divided into 2 parts, whereby the first part will be 2x2 comparing JUUL/NJOY 5% and 3%/2.4% to test the effects of partial nicotine reduction, and the second part will be using the NIDA Standardized Research Electronic Cigarette (SREC) for Clinical Research 5% and 0% (placebo), to test the effect of the total reduction using the same pods and juices from the same manufacturer.
The investigators hypothesize that NR will be associated with less satisfaction, withdrawal suppression, and intention to use and that such an effect will be more pronounced in total compared to partial NR and among high compared to low-dependency users. The proposed studies aim to answer 3 main regulatory questions: 1) is NR a promising regulatory option to reduce ENDS addictiveness and use; 2) what is the effect of partial vs. total NR on compensatory puffing and exposure to nicotine and respiratory toxicants, and 3) what is the effect of NR on ENDS users at different stages of their use. Combined, these studies will give direct and standardized evidence on the potential of NR regulations to limit the addictiveness and use of ENDS, and to help predict any potential side effects of NR on ENDS users' exposure to harmful toxicants.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Crossover
- Primary Purpose
- Prevention
- Masking
- None
Eligibility Criteria
- Ages
- 21 Years to 35 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Generally healthy individuals (determined by physical examination).
- •Age of 21-35 years.
- •Is willing to provide informed consent.
- •Is willing to attend the lab as required by the study protocol.
- •Electronic cigarette users (defined as using electronic cigarette either daily or occasionally in the past 30 days)
- •Have abstained from electronic cigarette use for 12 hours prior to each session
Exclusion Criteria
- •Report smoking cigarettes regularly (> 5 cigarettes/month in the past year).
- •Report regular use of any other tobacco/nicotine product (e.g.,hookah, pipes, cigars) in the past year.
- •Women who are breast-feeding or test positive for pregnancy (by urinalysis at screening).
- •Individuals with self-reported history of chronic disease or current psychiatric conditions.
- •Individuals with history of or active cardiovascular disease, low or high blood pressure, seizures, and regular use of prescription medications (other than vitamins or birth control).
- •Individuals that report current THC (marijuana) smoking/vaping.
- •Individuals that report the use of non-commercial (i.e., street) e-cigarette liquid or products
- •Individuals that report current EVALI or COVID-19 related symptoms (i.e., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhea, fever, chills, or weight loss)
- •Individuals that have or have been exposed to COVID-19 in the last 14 days.
Arms & Interventions
Partial Nicotine Reduction: Electronic cigarette pods with 5% nicotine concentration
For the partial nicotine reduction study, participants will complete a lab visit where they will use 5% nicotine electronic cigarette pods (JUUL/NJOY) ad libitum for up to 60 minutes.
Intervention: 5% nicotine (Partial Nicotine Reduction) (Other)
Partial Nicotine Reduction: Electronic cigarette pods with 3% or 2.4% nicotine concentration
For the partial nicotine reduction study, participants will complete a lab visit where they will use 3% or 2.4% nicotine electronic cigarette pods (JUUL/NJOY) ad libitum for up to 60 minutes.
Intervention: 3% or 2.4% nicotine (Partial Nicotine Reduction) (Other)
Total Nicotine Reduction: Electronic cigarette pods with 5% nicotine concentration
For the total nicotine reduction study, participants will complete a lab visit where they will use 5% nicotine electronic cigarette pods (SREC) ad libitum for up to 60 minutes.
Intervention: 5% nicotine (Total Nicotine Reduction) (Other)
Total Nicotine Reduction: Electronic cigarette pods with 0% nicotine concentration
For the total nicotine reduction study, participants will complete a lab visit where they will use 0% nicotine electronic cigarette pods (SREC) ad libitum for up to 60 minutes.
Intervention: 0% nicotine (Total Nicotine Reduction) (Other)
Outcomes
Primary Outcomes
Plasma Nicotine Boost
Time Frame: During the 2 participant visits, blood was taken 2 times in each session: before and after approximately 60 minutes ad lib use.
Change in plasma nicotine level. The plasma nicotine boost was calculated by subtracting the preplasma nicotine value from the postplasma value.
Secondary Outcomes
- Puff Topography (Total Puffing Time)(During participants' 2 study visits. Puffing behavior is continuously measured during each electronic cigarette use session (an approximately 60 minutes ad lib use period))
- Puff Topography (Average Puff Duration)(During participants' 2 study visits. Puffing behavior is continuously measured during each electronic cigarette use session (an approximately 60 minutes ad lib use period))
- Puff Topography (Puff Number)(During participants' 2 study visits. Puffing behavior is continuously measured during each electronic cigarette use session (an approximately 60 minutes ad lib use period))
- Puff Topography (Inhaled Volume)(During participants' 2 study visits. Puffing behavior is continuously measured during each electronic cigarette use session (an approximately 60 minutes ad lib use period))
- Toxicants (Carcinogenic and Probably or Possibly Carcinogenic) Exposure(During the 2 participant visits for both trials (partial and total). Toxicant exposure was measured after an approximately 60 minutes ad lib electronic cigarette use period.)
- TPM (Total Particular Matter) Exposure(During the 2 participant visits for both trials (partial and total). Total Particular Matter exposure was measured after an approximately 60 minutes ad lib electronic cigarette use period.)
- Lung Function Tests (LFTs) Change(During participants' 2 study visits. Lung function tests will be measured 2 times in each electronic cigarette use session: before and after an approximately 60 minutes ad lib use period)
- Lung Function Tests (LFTs) (% Predicted Change)(During participants' 2 study visits. Lung function tests will be measured 2 times in each electronic cigarette use session: before and after an approximately 60 minutes ad lib use period)
- Minnesota Nicotine Withdrawal Scale (MNWS)(During participants' 2 study visits. Questionnaire will be administered 2 times in each electronic cigarette use session: before and after an approximately 60 minutes ad lib use period)
- Tiffany-Drobes Questionnaire of Smoking Urges (QSU)(During participants' 2 study visits. Questionnaire will be administered 2 times in each electronic cigarette use session: before and after an approximately 60 minutes ad lib use period)
- Duke Sensory Questionnaire (DSQ)(During participants' 2 study visits. Questionnaire will be administered after each of the 2 electronic cigarette use sessions. Each session is approximately 60 minutes ad lib use period)
- Modified Cigarette Evaluation Questionnaire (mCEQ)(During participants' 2 study visits. Questionnaire will be administered after each of the 2 electronic cigarette use sessions. Each session is approximately 60 minutes ad lib use period)
- Visual Analogue Scale (VAS)(During participants' 2 study visits. Questionnaire will be administered after each of the 2 electronic cigarette use sessions. Each session is approximately 60 minutes ad lib use period)