INTRODUCTION:For adults who smoke (AWS) but are unable to quit, transitioning to less harmful nicotine products such as electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) may be a viable option for reducing exposure to tobacco-related toxicants. While the use of e-cigarettes and HTPs has proliferated among White AWS, little is known about the acceptability of these products among Black AWS. METHODS:Twenty-two Black (n = 12) and White (n = 10) AWS completed a randomized crossover study of their usual brand cigarette (UBC), an e-cigarette (menthol or tobacco flavored 5% JUUL), and an HTP (menthol or tobacco flavored IQOS). At each visit, nicotine-deprived AWS completed a standardized 10-puff bout of the product followed by a 50-minute ad-libitum smoking/vaping session. Puff topography was measured throughout. At the end of each session, subjective effects and behavioral intentions were assessed. RESULTS:UBC were rated as more pleasurable and satisfying compared to HTP (ps < 0.05) but the three products were rated similarly on the other subjective effects items (ps < 0.05). Participants reported greater behavioral intentions for UBC than HTP (ps < 0.05) but not e-cigarette. Within the 10-puff bout, cigarettes showed a lower flow rate relative to e-cigarettes and HTP (p < 0.001) and e-cigarettes showed a greater maximum puff volume compared to cigarettes (p = 0.017). DISCUSSION:Some subjective effects and most behavioral intention items showed a preference for cigarettes compared to HTP. There were no significant differences between the other products. Research is required to investigate how these findings translate to real world use and uptake among Black AWS.

INTRODUCTION:As many as 40% of adults who smoke (AWS) use cannabis, yet little is known about how cigarette-cannabis (CIG-CAN) use impacts change in cigarette and other tobacco product (OTP) use during a quit attempt. METHODS:Secondary data analysis of a smoking cessation randomized clinical trial (RCT) that enrolled 392 Black adults who wanted to quit cigarettes and were provided 18 weeks of standard or adapted pharmacotherapy. Participants self-reported cigarettes, cannabis, and OTP at W0, 2, 6, 12, 18, and 26. Longitudinal modeling of group, time, and group by time effects compared change in cigarettes, cannabis, and OTP between those who did and did not use cannabis. RESULTS:Nearly half (47.2%,185/392) were CIG-CAN users. Cannabis types were joints (78.4%) and blunts (51.9%). Significant reduction in CPD over time (p = .02) did not differ by group (p = .18). OTP had significant group, group by time interaction and time effect (p < .001), however, OTP use is small and had minimal effect on consumption. CIG-CAN increased cannabis use through week 26 (p < .001). When CPD decreased, there was a compensatory effect on OTP (< .0001), but not cannabis (p = .37). CONCLUSION:Prevalence of cannabis use was high among Black adults attempting to quit cigarette smoking in an RCT. OTP use was minimal, but CIG-CAN maintained higher OTP and increased consumption of cannabis while having similar reductions in CPD. Findings require replication in a prospectively designed study but suggest a pattern of compensation, primarily with cannabis, among CIG-CAN that may limit potential health benefit of cigarette reduction and could compromise future attempts at cessation.Trial registration: NCT03897439.

Introduction:Patients suffering from chronic obstructive pulmonary disease (COPD) who smoke often face significant challenges when attempting to quit. However, switching to less harmful alternatives such as electronic cigarettes (e-cigarettes) may help mitigate tobacco-related health outcomes. Training COPD patients who smoke to adjust their puffing topography could enhance nicotine delivery and satisfaction, thereby facilitating their transition to less harmful alternatives. This pilot study examined a novel puffing topography feedback intervention to facilitate switching to e-cigarettes among COPD patients. Methods:The study participants (N = 46) completed a 12-week e-cigarette switching trial in which they were randomized (1, 1:1) to (1) brief advice, (2) low-intensity, or (3) high-intensity topography training. This approach differed in the extent to which participants took longer puffs to maximize nicotine delivery, alleviate craving and withdrawal symptoms, and facilitate switching. Lab-based vaping sessions were conducted at weeks 0 (visits 1 and 2; separated by 48 h) and 12 (visit 3) to assess changes in puff duration (primary outcome), craving, withdrawal symptoms, and nicotine delivery. Effect size estimates are presented. Results:Puff duration was similar across conditions at baseline (range: 1.14-1.70s), and contrary to the hypotheses, neither low- nor high-intensity training led to meaningful changes in puff duration over time compared to brief advice (Hedge's g = 0.34). While the effects were minimal, the brief advice condition demonstrated the highest rate of complete switching (38.5%) and the largest reduction in cigarette smoking (M∆ = -17.6, SD = 10.0; Hedge's g = 0.78) across treatment groups. Discussion:E-cigarettes exhibit high potential to minimize harm in COPD patients who smoke. However, puff topography training did not alter switch success or reduction in cigarette smoking as compared to the brief advice to switch. Clinical trial registration:NCT05510154 https://clinicaltrials.gov/study/NCT05510154.

[This corrects the article DOI: 10.3389/fpubh.2025.1664400.].

E-cigarettes and heated tobacco products are marketed as safer combustible cigarette alternatives due to their perceived potential for reduced tobacco-related toxicant exposure; however, their relative safety remains controversial. In this study we utilized serum protease levels, established biomarkers of harm contributing to lung disease, to study the effects of alternate tobacco products. Twenty-one adults who smoke cigarettes completed three visits in a randomized crossover design, separated by a 48-h washout period. Participants used their usual brand of cigarette (UBC), e-cigarette (JUUL), and heated tobacco (IQOS). We quantified serum proteases (matrix metalloproteinase (MMP) 1, MMP9, and neutrophil elastase (NE) using graphene-based nanobiosensors. UBC delivered significantly greater peak nicotine concentrations compared to JUUL or IQOS. Every device increased peak serum protease levels. After adjustment for serum nicotine, JUUL use resulted in higher levels of NE and MMP1 compared to UBC. Hierarchical clustering revealed three distinct patterns of systemic protease production that agnostically grouped by device. We demonstrated that e-cigarettes, but not IQOS, exhibited increased risk of potentially pathogenic protease release compared to UBC. These data indicate the need for prospectively designed and fully powered studies of longer duration to better understand the relative risks of e-cigarettes, IQOS and cigarettes on protease activation.

Introduction: E-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers.Aims and Methods: Twenty-two nicotine-deprived people who smoke (black [n = 12] and white [n = 10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal.Results: UBC delivered significantly greater levels of nicotine compared to the e-cigarette (p < .001) and HTP (p < .01) during both the standardized and ad libitum sessions. HTP delivered more nicotine than the e-cigarette during the standardized puffing session (p = .047) but not the ad libitum session. Only craving during the standardized puffing session and not the ad libitum session showed significant differences across products (p < .001) such that UBC resulted in the greatest reduction followed by HTP and e-cigarette.Conclusions: Despite greater nicotine delivery from the UBC compared to e-cigarette and HTP, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use.Implications: Use of participant's UBCs (UBC) resulted in greater nicotine delivery compared to both the e-cigarette and HTP. Despite this relative difference in nicotine delivery, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. These findings suggest that in this sample of black and white people who smoke, HTPs and e-cigarettes provided significant relief from negative symptoms that maintain smoking.

Background: The proposed FDA product standard to prohibit menthol as a characterizing flavor in combustible cigarettes has the potential to significantly reduce tobacco -related health disparities. Whether a menthol e -liquid product standard would improve or hinder public health is unknown. No known research has directly examined the impact of menthol vs. tobacco flavored e -liquid use on acute e -cigarette use patterns, subjective experience, behavioral intentions, and craving and withdrawal among menthol cigarette smokers. Methods: Black ( n = 47) and White ( n = 4) nicotine -deprived menthol smokers with limited e -cigarette experience completed two counterbalanced in -laboratory 30 -minute ad libitum vaping sessions with menthol and tobacco nicotine salt -based e -liquid in a randomized crossover pilot trial design. Questionnaires assessed reductions in craving and withdrawal and post -session subjective experience and behavioral intentions. Puff topography was measured continuously throughout each vaping session. Results: Measures of puff topography did not differ significantly by e -liquid flavor (all p > .40). Similarly, menthol and tobacco flavored e -cigarettes were both rated positively in terms of subjective effects and behavioral intentions (all p > .10) and about 40 % of participants reported a preference for the tobacco -flavored e -liquid. Finally, participants showed comparable reductions in craving ( p = .210) and withdrawal ( p = .671) from preand post -session regardless of e -liquid flavor. Conclusions: Among menthol smokers in a lab -based setting, findings suggest that menthol vs tobacco e -liquid flavor has little impact on acute changes in puff patterns, subjective experience, behavioral intentions, or craving and withdrawal.

INTRODUCTION:Alternative nicotine delivery products, including electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs), contain fewer toxicants than combustible cigarettes and offer a potential for harm reduction. Research on the substitutability of e-cigarettes and HTPs is crucial for understanding their impact on public health. This study examined subjective and behavioral preferences for an e-cigarette and HTP relative to participants' usual brand combustible cigarette (UBC) in African American and White smokers naïve to alternative products. AIMS AND METHODS:Twenty-two adult African American (n = 12) and White (n = 10) smokers completed randomized study sessions with their UBC and study provided e-cigarette and HTP. A concurrent choice task allowed participants to earn puffs of the products but placed UBC on a progressive ratio schedule, making puffs harder to earn, and e-cigarette and HTP on a fixed ratio schedule to assess behavioral preference for the products. Behavioral preference was then compared to self-reported subjective preference. RESULTS:Most participants had a subjective preference for UBC (n = 11, 52.4%), followed by an equal preference for e-cigarette (n = 5, 23.8%) and HTP (n = 5, 23.8%). During the concurrent choice task, participants showed a behavioral preference (i.e., more earned puffs) for the e-cigarette (n = 9, 42.9%), followed by HTP (n = 8, 38.1%), and UBC (n = 4, 19.1%). Participants earned significantly more puffs of the alternative products compared to UBC (p = .011) with no difference in earned puffs between e-cigarettes and HTP (p = .806). CONCLUSIONS:In a simulated lab setting, African American and White smokers were willing to substitute UBC for an e-cigarette or HTP when the attainment of UBC became more difficult. TRIAL REGISTRATION:NCT04646668. IMPLICATIONS:Findings suggest that African American and White smokers are willing to substitute their UBC for an alternative nicotine delivery product (e-cigarette or HTP) when the attainment of cigarettes became more difficult in a simulated lab setting. Findings require confirmation among a larger sample under real-world conditions but add to growing evidence suggesting the acceptability of alternative nicotine delivery products among racially diverse smokers. These data are important as policies that limit the availability or appeal of combustible cigarettes are considered or enacted.

INTRODUCTION:People who smoke cigarettes are more likely than people who do not to use cannabis, including blunts, a tobacco product containing nicotine and marijuana. Blunts represent a challenge for cessation trials because nicotine could make stopping cigarettes more difficult. Few studies have examined the impact of blunt use on individuals actively engaged in a cigarette quit attempt. METHODS:Blunt use was assessed at baseline, Weeks 4, 8, 12, 16, and 26 among Black adult people who smoke enrolled in a double-blind, placebo-controlled, randomized trial of varenicline (VAR, n = 300) versus placebo (PBO, n = 200) for smoking cessation. Participants were categorized as ever blunt (blunt use reported at any timepoint) versus non-blunt (no blunt use reported). The primary outcome was salivary cotinine-verified 7-day point prevalence smoking abstinence at Weeks 12 and 26. Logistic regression examined the effects of treatment and blunt use on abstinence. RESULTS:75 participants (mean age 45.6 years (SD = 12.5, range: 22,80); 32 (42%) female) reported blunt use. Logistic regression analyses showed no treatment by blunt use interaction or significant main effect of blunt use on smoking abstinence at Weeks 12 or 26 (p > 0.05). After adjusting for treatment, those who used blunts had statistically similar odds of quitting at Week 12 (OR: 0.68, 95% CI: 0.31, 1.5) and Week 26 (OR: 0.84, 95% CI: 0.38, 1.87) as those who never used blunts during the study. DISCUSSION:Blunt use had no statistically significant impact on cessation among participants in a smoking cessation clinical trial. Future trials are needed in which the target of cessation is all combustible products.

Background In rural America, cigarette smoking is prevalent and health care providers lack the time and resources to help smokers quit. Telephone quitlines are important avenues for cessation services in rural areas, but they are poorly integrated with local health care resources. Objective The intent of the study was to assess the comparative effectiveness and cost effectiveness of two models for delivering expert tobacco treatment at a distance: telemedicine counseling that was integrated into smokers’ primary care clinics (Integrated Telemedicine—ITM) versus telephone counseling, similar to telephone quitline counseling, delivered to smokers in their homes (Phone). Methods Smokers (n=566) were recruited offline from 20 primary care and safety net clinics across Kansas. They were randomly assigned to receive 4 sessions of ITM or 4 sessions of Phone counseling. Patients in ITM received real-time video counseling, similar to Skype, delivered by computer/webcams in clinic exam rooms. Three full-time equivalent trained counselors delivered the counseling. The counseling duration and content was the same in both groups and was available in Spanish or English. Both groups also received identical materials and assistance in selecting and obtaining cessation medications. The primary outcome was verified 7-day point prevalence smoking abstinence at month 12, using an intent-to-treat analysis. Results There were no significant baseline differences between groups, and the trial achieved 88% follow-up at 12 months. Verified abstinence at 12 months did not significantly differ between ITM or Phone (9.8%, 27/280 vs 12%, 34/286; P=.406). Phone participants completed somewhat more counseling sessions than ITM (mean 2.6, SD 1.5 vs mean 2.4, SD 1.5; P=.0837); however, participants in ITM were significantly more likely to use cessation medications than participants in Phone (55.9%, 128/280 vs 46.1%, 107/286; P=.03). Compared to Phone participants, ITM participants were significantly more likely to recommend the program to a family member or friend (P=.0075). From the combined provider plus participant (societal) perspective, Phone was significantly less costly than ITM. Participants in ITM had to incur time and mileage costs to travel to clinics for ITM sessions. From the provider perspective, counseling costs were similar between ITM (US $45.46, SD 31.50) and Phone (US $49.58, SD 33.35); however, total provider costs varied widely depending on how the clinic space for delivering ITM was valued. Conclusions Findings did not support the superiority of ITM over telephone counseling for helping rural patients quit smoking. ITM increased utilization of cessation pharmacotherapy and produced higher participant satisfaction, but Phone counseling was significantly less expensive. Future interventions could combine elements of both approaches to optimize pharmacotherapy utilization, counseling adherence, and satisfaction. Such an approach could commence with a telemedicine-delivered clinic office visit for pharmacotherapy guidance, and continue with telephone or real-time video counseling delivered via mobile phones to flexibly deliver behavioral support to patients where they most need it—in their homes and communities. Trial Registration Clinicaltrials.gov NCT00843505; http://clinicaltrials.gov/ct2/show/NCT00843505 (Archived by WebCite at http://www.webcitation.org/6YKSinVZ9).

IntroductionIn rural America cigarette smoking is prevalent, few cessation services are available, and healthcare providers lack the time and resources to help smokers quit. This paper describes the design and participant characteristics of Connect2Quit (C2Q), a randomized control trial (RCT) that tests the effectiveness and cost-effectiveness of integrated telemedicine counseling delivered by 2-way webcams mounted on desktop computers in participant's physician office examining rooms (ITM) versus quitline counseling delivered by telephone in participant's homes (Phone) for helping rural smokers quit.Methods/designC2Q was implemented in twenty primary care and safety net clinics. Integrated telemedicine consisted of real-time video counseling, delivered to patients in their primary care physician's (PCP) office. Phone counseling, was delivered to patients in their homes. All participants received educational materials and guidance in selecting cessation medications.ResultsThe 566 participants were predominantly Caucasian (92%); 9% were Latino. Most (65%) earned <200% of Federal Poverty Level. One out of three lacked home internet access, 40% were not comfortable using computers, and only 4% had been seen by a doctor via telemedicine in the past. Hypertension, chronic lung disease, and diabetes were highly prevalent. Participants smoked nearly a pack a day and were highly motivated to quit.DiscussionC2Q is reaching a rural low-income population, with comorbid chronic diseases, that would benefit greatly from quitting smoking. ITM is a good delivery model, which integrates care by holding counseling sessions in the patient's PCP office and keeps the primary care team updated on patients' progress.Trial registrationClinical trials registration: NCT00843505