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Completed

NCT Number: NCT05320887

Cigarette and E-cigarette Nicotine Content in an Electronic Tobacco Marketplace (ETM)

This study is proposing a four condition Electronic Tobacco Marketplace (ETM) study to determine if banning normal nicotine content (NNC) is sufficient for encouraging smokers to switch to potentially less harmful products or if the availability of higher nicotine and/or flavored alternative products (specifically e-cigarettes) are needed to achieve maximal reductions in smoking.

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Key information

Age range

21 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Wake Forest University Health Sciences

Winston-Salem, North Carolina, 27157, United States

About this study

The Family Smoking Prevention and Tobacco Control Act (FSPTCA) passed in 2009 provides the FDA with the authority to regulate tobacco products. One provision in this legislative act empowers the FDA to set limits on constituents in tobacco products, including nicotine. Such a measure has the potential to reduce the chance of individuals experimenting with smoking from becoming dependent and enable current smokers to quit when they are motivated to do so. Although the proposal to reduce nicotine in cigarettes has been met with skepticism by some because of concerns over compensatory smoking behavior and the potential emergence of a black market, this policy measure was considered to be technically feasible by the American Medical Association and the British Medical, by tobacco control researchers, policymakers and governmental officials who were convened in a meeting on nicotine regulation8, and by the World Health Organization Study Group on Tobacco Product Regulation. Most importantly, in July 2017, FDA Commissioner Gottlieb announced he was "directing our Center for Tobacco Products to develop a comprehensive nicotine regulatory plan premised on the need to confront and alter cigarette addiction." This announcement was followed on March 16, 2018 by the release of the Advance Notice of Proposed Rulemaking entitled "Tobacco Product Standard for Nicotine Level of Combusted Cigarettes" (ID: FDA-2017-N-6189-0001) "to obtain information for consideration in developing a tobacco product standard to set the maximum nicotine level for cigarettes."

This study proposes to conduct a within-subjects, multi-session virtual lab study and validation field assessment to determine how the availability of flavored e-liquids affects product purchasing among cigarette smokers. Adult daily cigarette smokers (N=64) will be recruited for this study. After initial eligibility is assessed, participants will complete six virtual sessions (1 baseline, 4 experimental, and 1 follow-up) and one field assessment to evaluate their tobacco use.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 21+ years of age
  • Self-report smoking at least 5 cigarettes per day for the past year
  • Breathe carbon monoxide (CO) level > 8 ppm or positive urine NicCheck
  • Willingness to use other tobacco products during the study
  • Speak, comprehend, and read English sufficiently to complete study procedures
  • Have home access to a computer, smart phone, or tablet with a web camera and internet access
  • Tried a vaping device at least once in their lifetime

Exclusion criteria

  • Currently seeking treatment to quit smoking
  • Self-reported serious medical or psychiatric condition(s) including cardiovascular and chronic respiratory diseases
  • Body temperature > 100.4 F
  • Cold, flu or COVID-19 symptoms including fever, cough, and runny nose in the past 30 days
  • Currently pregnant, breastfeeding or intending to become pregnant for the duration of the study or unwilling to agree to use adequate protection to avoid pregnancy
  • CO reading > 80 ppm

Treatment and study plan

Normal Nicotine Content Vape with all flavor e-liquids

Other

Participants are randomly assigned to the order of each marketplace Group

Normal nicotine content vape with tobacco e-liquids

Other

Participants are randomly assigned to the order of each marketplace Group

Low nicotine content vape with all flavor e-liquids

Other

Participants are randomly assigned to the order of each marketplace Group

Low nicotine content vape with tobacco e-liquids

Other

Participants are randomly assigned to the order of each marketplace Group

Primary outcomes

  1. Number of Cigarettes Purchased

    Time frame: Visit 6 approximately 4 weeks after baseline

    Average number of cigarettes purchased (analyzed as raw data and using derived behavioral economic measures)

Secondary outcomes

  1. Number of E-liquid Milliliters Purchased

    Time frame: Visit 6 approximately 4 weeks after baseline

    Average number of e-liquid milliliters purchased (analyzed as raw data and using derived behavioral economic measures)

  2. Proportion of Participants Completing Flavor and Nicotine Content Discrete Choice Projections

    Time frame: Month 1 after baseline

    The proportion of participants projected to choose a cigarette over an e-cigarette under different potential regulatory scenarios, as determined by regression analysis.

  3. Lung Cancer Perceived Risk Scores for VLNC Cigarettes

    Time frame: Baseline

    The response options rely on a 10-point Likert-like scale: 1 = very low risk of disease; 2, 3, 4, 5, 6, 7, 8, 9, 10 = very high risk of disease. Minimum possible response 1. Maximum possible response 10. The higher the score, the greater perceived risk of VLNC cigarettes for lung cancer.

  4. Product Evaluation Scale Scores

    Time frame: Visit 6 approximately 4 weeks after baseline

    Product evaluation scale scores for VLNC cigarettes among participants who received VLNC cigarettes will be determined by a product evaluation questionnaire. The questionnaire measures the strength of self-reported positive subjective effects (e.g., reward, satisfaction) following product use. The response options rely on a 7-point Likert-like scale: 1=not at all; 2= very little; 3= a little; 4= moderately; 5= a lot; 6= quite a lot; 7= extremely. The summed score adds responses to 13 separate items. Minimum possible response: 13. Maximum possible response: 91. Higher scores denote more favorable product effects. Note: This was only administered (at Virtual Visit 6) to participants who received each product type in the field (dependent on their baseline ETM shopping trip purchases).

  5. Minnesota Nicotine Withdrawal Scale Scores

    Time frame: Visit 6 approximately 4 weeks after baseline

    Minnesota Nicotine Withdrawal Scale measures the severity of nicotine withdrawal symptoms. The response options rely on a 5-point Likert-like scale; 0=None; 1= Slight; 2=Mild; 3=Moderate; 4=Severe. There are 7 items total, that are summed. Minimum possible response: 0. Maximum possible response: 28. Higher scores denote greater severity of withdrawal symptoms.

  6. Questionnaire on Smoking Urges Score

    Time frame: Visit 6 approximately 4 weeks after baseline

    Questionnaire on Smoking Urges measures the strength of urges to smoke. The response options rely on a 7-point Likert-like scale: 1=Strongly Disagree; 2; 3; 4; 5; 6; 7= Strongly Agree. The questionnaire has 10 total items; scores sum responses to each item. Minimum possible response: 10. Maximum possible response: 70. Higher scores denote greater urges to smoke.

  7. Tobacco Product Interest Scores

    Time frame: 1 month after baseline

    Tobacco Product Interest of different products; Slider scale ranging from 0=No Interest to 100=Very Interested

  8. Tobacco Policy Questionnaire Scores

    Time frame: 1 month after baseline

    Tobacco Policy Questionnaire scored from Support, Oppose, and Don't know for personal opinions on Making Cigarettes Less Addictive

Other outcomes

  1. Product Use Themes Emerging From the Qualitative Interviews

    Time frame: Screening visit through end of study (up to week eight)

    Participants are asked about their opinions and experiences using tobacco products other than their usual brand during the field assessment.

  2. Tobacco Product Use During Field Assessment

    Time frame: Screening visit through end of study (up to week eight)

    Participants are asked what products they had used and quantity every day during the field assessment.

  3. Biomarkers of Exposure During Field Assessment - Carbon Monoxide

    Time frame: Screening visit through end of study (up to week eight)

    Product use and biomarkers of exposure during the field assessment will be analyzed using linear regression or other appropriate regression models. The model for primary analysis of these data will include main effects for each of the two factors (for the ETM condition carried into the field assessment), and the corresponding baseline measure to improve precision. Carbon Monoxide (CO) is collected in ppm.

  4. Biomarkers of Exposure During Field Assessment - Cotinine

    Time frame: Screening visit through end of study (up to week eight)

    Product use and biomarkers of exposure during the field assessment will be analyzed using linear regression or other appropriate regression models. The model for primary analysis of these data will include main effects for each of the two factors (for the ETM condition carried into the field assessment), and the corresponding baseline measure to improve precision. Cotinine is collected in ng/ml.

Sponsors and collaborators

Lead sponsor

Wake Forest University Health Sciences

Other

Collaborators

  • National Institute on Drug Abuse (NIDA)
  • National Institutes of Health (NIH)

Registry information

Official study title

The Impact of Cigarette Nicotine Content, E-Cigarette Nicotine Content and E-Cigarette Flavoring on Smoking Behavior in an Electronic Tobacco Marketplace

Important dates

Study start
2022
Primary completion
2023
Study completion
2023
First posted
Apr 11, 2022
Registry last updated
Oct 9, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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