Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naïve adult smokers

Abstract

Nicotine vaping products (NVPs) and heated tobacco products (HTPs) are designed to replicate the sensory and behavioural aspects of smoking cigarettes while avoiding combustion. The success of these products as harm reduction tools will partially depend on their ability to satisfy smokers and alleviate nicotine-related withdrawal symptoms. This study aims to compare short-term effects of NVPs (Juul and Aspire PockeX) versus HTPs (IQOS) on smoking-related withdrawal relief, product satisfaction, intention to switch to NVP/HTP, perceptions and attitudes in UK adult cigarette smokers naïve to these products. In a randomized cross-over study, 45 participants visited the lab twice, at each visit trying one of the two products (NVP/HTP) and completing a questionnaire. Responses were normalized on a 0-100% scale and mean differences (MD) between NVP and HTP scores computed, with positive and negative MD values indicating greater endorsement for NVP and HTP, respectively. Cigarette cravings were reduced similarly (~ 20.0%) by both products (MD = 4.5%, 95%Confidence Interval (CI) - 4.8, 13.8). Direct positive effects (MD = - 3.5%, 95%CI - 7.2, 0.2) and adverse side effects (MD = 1.8%, 95%CI - 0.3, 3.8) were comparable after each product use, though marginally favouring HTPs. HTPs were perceived as more satisfying overall (MD = - 13.2%, 95%CI - 20.3 - 6.1) than NVPs but both were perceived as similarly addictive (MD = 3.6%, 95%CI - 4.6, 11.8), relative to cigarettes. Intention to switch to either product was comparable (MD = 4.0%, 95%CI - 5.7, 13.8). Comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes.Registration: The analysis plan was pre-registered, and it is available at https://osf.io/6ymdu.

Figure 1

Cigarette smoking related withdrawal relief after NVP and HTP use. NVP = nicotine vaping product, HTP = heated tobacco product, SD = standard deviation, MD* = mean within-person difference in the outcome variable after NVP use minus HTP use with adjustment for both period and the mean difference in variable before product use, CI = Confidence Interval. Cigarette cravings were measured on a 6-point Likert scale from 1 = ‘no urges’ to 6 = ‘extremely strong’. All the others were measured on a 5-point Likert scale, 1 = ‘not at all’ to 5 = ‘extremely’. All scales were normalised on 0% to 100%.

Figure 2

Acute positive effects after NVP and HTP use. NVP = nicotine vaping product, HTP = heated tobacco product, SD = standard deviation, MD* = mean within-person difference in outcome after NVP use minus HTP use with adjustment for period, CI = Confidence Intervals. Answer option a 10-point Likert scale, 1 = ‘not at all’ to 10 = ‘extremely’, normalised on 0% to 100% scale.

Figure 3

Adverse side-effects after NVP and HTP use. NVP = nicotine vaping product, HTP = heated tobacco product, SD = standard deviation, MD* = mean within-person difference in outcome after NVP use minus HTP use with adjustment for period, CI = Confidence Intervals. Answer option a 10-point Likert scale, 1 = ‘not at all’ to 10 = ‘extremely’, normalised on 0% to 100% scale.

Figure 4

Perceptions about the addictiveness, satisfaction, and safety of NVPs and HTPs compared with cigarettes.

Figure 5

Reasons that would motivate switching from cigarettes to NVPs/HTPs. NVP = nicotine vaping product, HTP = heated tobacco product, SD = standard deviation, MD* = mean within-person difference in outcome after NVP use minus HTP use with adjustment for period, CI = Confidence Intervals. Normalised on 0% to 100% scale. Answer options on a 5-point Likert scale, 1 = ‘not at all’ to 5 = ‘extremely’, normalised on 0% to 100% scale.