The Impact of Nicotine Reduction on Cigarette Reinforcement Value Within a Marketplace Containing Alternative Nicotine Delivery Products: A Secondary Analysis of a Multi-Site Trial.

introductionA mandated reduction in the nicotine content of cigarettes would likely improve public health. Prior research has shown that assignment to very low nicotine content (VLNC) cigarettes reduces the reinforcement value of cigarettes. However, no studies have evaluated changes in reinforcement for smoking after experience with VLNC cigarettes in a marketplace where noncombusted nicotine products are available. AIMS AND

methodsAdult participants who smoke cigarettes (n = 438) were randomized 1:1 to VLNC or normal nicotine content cigarettes for 12 weeks. Participants purchased products using points valued at $1 from an experimental tobacco marketplace that contained study cigarettes and noncombusted nicotine products. At the 12-week visit, participants completed hypothetical purchase tasks for each product. Demand parameters were calculated, including intensity (consumption when product is free), breakpoint (price when consumption is reduced to zero), Pmax (price that produces maximum daily spending), Omax (maximum amount spent in a single day), and α (rate of change in consumption across the demand curve).

resultsAssignment to VLNC cigarettes reduced demand for study cigarettes across all parameters, and reduced demand for usual brand cigarettes for intensity and breakpoint, but not other parameters. Assignment to VLNC cigarettes increased Omax for e-cigarettes, but not other demand parameters. There were no significant differences in demand parameters for other products.

conclusionsA mandated reduction in cigarette nicotine content is likely to reduce the reinforcement value of cigarettes in a marketplace where noncombusted products are available, which may drive reductions in the prevalence of smoking and shift people who smoke toward noncombusted products. IMPLICATIONS: This is the first study to show that assignment to VLNC cigarettes along with access to noncombusted nicotine products reduces reinforcement value for both low nicotine and normal nicotine cigarettes, and may increase the reinforcement value of e-cigarettes. These results suggest that a mandated reduction in nicotine will decrease the prevalence of smoking and may increase the use of other noncombusted products.