Evaluating oral noncombustible potential-reduced exposure products for smokers

Abstract

Introduction: Potential-reduced exposure products (PREPs) are marketed as a way for smokers to continue using tobacco while possibly lessening their tobacco toxicant intake. Some tobacco-based PREPs are combustible and intended to be smoked, while others are noncombustible and intended to be administered orally (e.g., Camel Snus [CS] tobacco sachets and Ariva tobacco tablets). The ability of these noncombustible PREPs to reduce smokers' exposure to cigarette-delivered toxicants and suppress tobacco abstinence symptoms effectively is unclear. Clinical laboratory methods have been used to measure combustible PREP-associated toxicant exposure and abstinence symptom suppression and could be applied to evaluating the effects of orally administered noncombustible PREPs.

Methods: In this study, 21 smokers (6 women) participated in four 5-day conditions that differed by product used: CS, Ariva, own brand cigarettes, or no tobacco. Measures included expired-air carbon monoxide (CO), the urinary metabolite of nicotine (cotinine), the urinary metabolite of the carcinogen NNK (NNAL-T), and subjective effect ratings.

Results: Relative to own brand, all other conditions were associated with CO and cotinine levels that were lower and abstinence symptom ratings that were greater. Only no-tobacco use was associated with significantly lower NNAL levels. Acceptability ratings were also lower in all conditions relative to own brand.

Discussion: Although these oral products reduce exposure to CO, their ineffective abstinence symptom suppression and low acceptability may limit their viability as PREPs. As with combustible PREPs, clinical laboratory study of orally administered noncombustible PREPs will be a valuable part of any comprehensive PREP evaluation strategy.

Figure 1.

Mean data (±1 SEM) for expired-air carbon monoxide (CO; A), cotinine (B), and NNAL-T (C). Data are presented as condition (own brand, Ariva, Camel Snus, and no tobacco) by day (Days 1, 3, and 5 for NNAL-T and Days 1–5 for CO and cotinine). Filled symbols indicate a significant difference from Day 1 within that condition, and asterisks indicate a significant difference from own brand on that day (all ps < .05, Tukey’s Honestly Significant Difference post-hoc test).

Figure 2.

Mean data (±1 SEM) for H–H item craving (A) and “Are the tobacco products you are using this week pleasant?” (B). Data are presented as condition (own brand, Ariva, Camel Snus, and no tobacco) by day (Days 1–5 for craving and Days 2–5 for “Pleasant”). Filled symbols indicate a significant difference from Day 1 within that condition; asterisks indicate a significant difference from own brand on that day; pound signs indicate a significant difference from Ariva on that day (all ps < .05, Tukey’s Honestly Significant Difference post-hoc test).