A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure

Ellen Meier; Bruce R. Lindgren; Amanda Anderson; Sarah A. Reisinger; Kaila J. Norton; Joni Jensen; Lori Strayer; Laura Dick; Mei Kuen Tang; Menglan Chen; Steven G. Carmella; Stephen S. Hecht; Sharon E. Murphy; Jing Yang; Irina Stepanov; Richard J. O'Connor; Peter G. Shields; Dorothy K. Hatsukami

doi:10.1093/ntr/ntz055

A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure

Ellen Meier, Bruce R. Lindgren, Amanda Anderson, Sarah A. Reisinger, Kaila J. Norton, Joni Jensen, Lori Strayer, Laura Dick, Mei Kuen Tang, Menglan Chen, Steven G. Carmella, Stephen S. Hecht, Sharon E. Murphy, Jing Yang, Irina Stepanov, Richard J. O'Connor, Peter G. Shields, Dorothy K. Hatsukami

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

INTRODUCTION: This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.

METHOD: US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; "use snus as you like with your cigarettes"), (2) complete substitution (CS; "avoid cigarettes"), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).

RESULTS: Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N'-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.

CONCLUSIONS: Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.

IMPLICATIONS: Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.

Original language	English (US)
Pages (from-to)	473-481
Number of pages	9
Journal	Nicotine and Tobacco Research
Volume	22
Issue number	4
DOIs	https://doi.org/10.1093/ntr/ntz055
State	Published - Apr 1 2021

Bibliographical note

Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

Keywords

Adolescent
Adult
Biomarkers/metabolism
Carbon Monoxide/analysis
Female
Humans
Male
Middle Aged
Minnesota/epidemiology
New York/epidemiology
Nitrosamines/administration & dosage
Smoking/epidemiology
Smoking Cessation/methods
Tobacco Use Disorder/diagnosis
Tobacco, Smokeless/statistics & numerical data
Young Adult

PubMed: MeSH publication types

Randomized Controlled Trial
Journal Article
Research Support, N.I.H., Extramural
Comparative Study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1093/ntr/ntz055

Find It

Find It at U of M Libraries

Cite this

Meier, E., Lindgren, B. R., Anderson, A., Reisinger, S. A., Norton, K. J., Jensen, J., Strayer, L., Dick, L., Tang, M. K., Chen, M., Carmella, S. G., Hecht, S. S., Murphy, S. E., Yang, J., Stepanov, I., O'Connor, R. J., Shields, P. G., & Hatsukami, D. K. (2021). A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure. Nicotine and Tobacco Research, 22(4), 473-481. https://doi.org/10.1093/ntr/ntz055

Meier, E, Lindgren, BR, Anderson, A, Reisinger, SA, Norton, KJ, Jensen, J, Strayer, L, Dick, L, Tang, MK , Chen, M , Carmella, SG , Hecht, SS , Murphy, SE, Yang, J, Stepanov, I, O'Connor, RJ, Shields, PG & Hatsukami, DK 2021, 'A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure', Nicotine and Tobacco Research, vol. 22, no. 4, pp. 473-481. https://doi.org/10.1093/ntr/ntz055

@article{1c357e3edc6346f79962cc68fee2e710,

title = "A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure",

abstract = "INTRODUCTION: This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.METHOD: US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; {"}use snus as you like with your cigarettes{"}), (2) complete substitution (CS; {"}avoid cigarettes{"}), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).RESULTS: Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N'-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.CONCLUSIONS: Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.IMPLICATIONS: Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.",

keywords = "Adolescent, Adult, Biomarkers/metabolism, Carbon Monoxide/analysis, Female, Humans, Male, Middle Aged, Minnesota/epidemiology, New York/epidemiology, Nitrosamines/administration & dosage, Smoking/epidemiology, Smoking Cessation/methods, Tobacco Use Disorder/diagnosis, Tobacco, Smokeless/statistics & numerical data, Young Adult",

author = "Ellen Meier and Lindgren, {Bruce R.} and Amanda Anderson and Reisinger, {Sarah A.} and Norton, {Kaila J.} and Joni Jensen and Lori Strayer and Laura Dick and Tang, {Mei Kuen} and Menglan Chen and Carmella, {Steven G.} and Hecht, {Stephen S.} and Murphy, {Sharon E.} and Jing Yang and Irina Stepanov and O'Connor, {Richard J.} and Shields, {Peter G.} and Hatsukami, {Dorothy K.}",

year = "2021",

month = apr,

day = "1",

doi = "10.1093/ntr/ntz055",

language = "English (US)",

volume = "22",

pages = "473--481",

journal = "Nicotine and Tobacco Research",

issn = "1462-2203",

publisher = "Oxford University Press",

number = "4",

}

TY - JOUR

T1 - A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure

AU - Meier, Ellen

AU - Lindgren, Bruce R.

AU - Anderson, Amanda

AU - Reisinger, Sarah A.

AU - Norton, Kaila J.

AU - Jensen, Joni

AU - Strayer, Lori

AU - Dick, Laura

AU - Tang, Mei Kuen

AU - Chen, Menglan

AU - Carmella, Steven G.

AU - Hecht, Stephen S.

AU - Murphy, Sharon E.

AU - Yang, Jing

AU - Stepanov, Irina

AU - O'Connor, Richard J.

AU - Shields, Peter G.

AU - Hatsukami, Dorothy K.

PY - 2021/4/1

Y1 - 2021/4/1

N2 - INTRODUCTION: This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.METHOD: US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; "use snus as you like with your cigarettes"), (2) complete substitution (CS; "avoid cigarettes"), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).RESULTS: Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N'-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.CONCLUSIONS: Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.IMPLICATIONS: Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.

AB - INTRODUCTION: This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.METHOD: US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; "use snus as you like with your cigarettes"), (2) complete substitution (CS; "avoid cigarettes"), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).RESULTS: Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N'-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.CONCLUSIONS: Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.IMPLICATIONS: Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.

KW - Adolescent

KW - Adult

KW - Biomarkers/metabolism

KW - Carbon Monoxide/analysis

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Minnesota/epidemiology

KW - New York/epidemiology

KW - Nitrosamines/administration & dosage

KW - Smoking/epidemiology

KW - Smoking Cessation/methods

KW - Tobacco Use Disorder/diagnosis

KW - Tobacco, Smokeless/statistics & numerical data

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85080076589&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85080076589&partnerID=8YFLogxK

U2 - 10.1093/ntr/ntz055

DO - 10.1093/ntr/ntz055

M3 - Article

C2 - 31321423

AN - SCOPUS:85080076589

SN - 1462-2203

VL - 22

SP - 473

EP - 481

JO - Nicotine and Tobacco Research

JF - Nicotine and Tobacco Research

IS - 4

ER -

A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this