Smoking Topography Characteristics during a 6-Week Trial of Very Low Nicotine Content Cigarettes in Smokers with Serious Mental Illness

Rachel L. Denlinger-Apte, Eric C. Donny, Bruce R. Lindgren, Nathan Rubin, Christine Goodwin, Teresa Deatley, Suzanne M. Colby, Patricia A. Cioe, Dorothy K. Hatsukami, Jennifer W. Tidey

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


INTRODUCTION: A nicotine-reduction policy could have major benefits for smokers with serious mental illness (SMI). However, potential unintended consequences, such as compensatory smoking, should be considered to ensure that such a policy does not negatively affect this population. The purpose of this secondary analysis was to examine the impact of smoking very low nicotine content (VLNC) cigarettes for 6 weeks on smoking topography characteristics, indicators of compensatory smoking, among smokers with SMI.

AIMS AND METHODS: After a baseline usual brand smoking phase, smokers with SMI (N = 58) were randomly assigned under double-blind conditions to receive either VLNC (0.4 mg nicotine per g tobacco) or normal nicotine content (NNC; 15.8 mg nicotine per g tobacco) research cigarettes for 6 weeks. During two study visits scheduled 6 weeks apart, participants smoked either their usual brand (baseline) or assigned study cigarettes (postrandomization) through a handheld smoking topography device. Univariate analysis of variance compared smoking topography indices with cigarette condition (VLNC vs. NNC) as the between-subjects factor with corresponding baseline topography results included as covariates.

RESULTS: At week 6, participants in the VLNC condition smoked fewer puffs per cigarette and had shorter interpuff intervals compared to participants in the NNC condition (ps < .05). There were no differences between research cigarette conditions at week 6 for cigarette volume, puff volume, puff duration, peak flow rate, or carbon monoxide boost.

CONCLUSIONS: Findings are consistent with acute VLNC cigarette topography studies and indicate that a nicotine-reduction policy is unlikely to lead to compensation among smokers with SMI.

IMPLICATIONS: Given the high smoking rates among people with SMI, understanding how a nicotine-reduction policy may affect this population is critically important. When considering the smoking topography results as a whole, smokers with SMI did not engage in compensatory smoking behavior when using VLNC cigarettes during a 6-week trial. Study findings suggest that compensatory smoking is not likely to occur among smokers with SMI if nicotine content is lowered to minimally addictive levels.

Original languageEnglish (US)
Pages (from-to)1414-1418
Number of pages5
JournalNicotine and Tobacco Research
Issue number8
StatePublished - Aug 1 2020

Bibliographical note

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


  • Adolescent
  • Adult
  • Aged
  • Behavior, Addictive
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Mental Disorders/physiopathology
  • Middle Aged
  • Nicotine/administration & dosage
  • Smokers/psychology
  • Smoking/epidemiology
  • Smoking Cessation/methods
  • Tobacco Products/adverse effects
  • Young Adult

PubMed: MeSH publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Randomized Controlled Trial
  • Journal Article
  • Research Support, N.I.H., Extramural


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