Online

Harfmann, Roxanne F.

Psychology

2022

M.A.

Introduction: There is a pharmacological effect of nicotine on weight, such that reductions in nicotine exposure lead to weight gain. Weight gain may be an unintended consequence of a nicotine reduction policy. To our knowledge, two studies have examined the relationship between very low nicotine content cigarettes (VLNCs) and weight, both in general-population smokers. As would be expected, only smokers adherent to VLNCs gained weight. The aim of this study is to examine associations between VLNCs and weight among vulnerable populations. Methods: This is a secondary analysis of a double-blind, randomized controlled trial evaluating the effects of VLNCs among individuals from three vulnerable populations: smokers with affective disorders, opioid use disorder (OUD), and disadvantaged women. Participants were assigned to smoke one of three research cigarettes (15.8, 2.4, or 0.4-mg/g) over 12 weeks in lieu of their usual brand cigarettes. Biomarker levels did not differ considerably by cigarette dose among smokers with OUD, suggesting this population was less adherent. Thus, the present analyses examined associations between VLNCs and weight across all three populations but also grouped smokers with affective disorders and disadvantaged women together and examined smokers with OUD separately. Linear mixed models were used to examine differences in weight change and also a subjective measure, "increased appetite/hunger/weight gain," over time by cigarette dose. Results: Among all populations, there was no effect of dose on weight gain. There was a graded effect of dose on "increased appetite/hunger/weight gain" ratings during the 12-week study, with the 0.4-mg/g condition having the highest average rating, then the 2.4-mg/g condition, followed by the 15.8-mg/g condition, although only the comparison between the 0.4-mg/g and 15.8-mg/g cigarette conditions was statistically significant (1.95 vs. 1.73; p = .01). Analyses limited to participants with affective disorders and disadvantaged women demonstrated a graded effect of dose on weight gain during the 12-week study, with the 0.4-mg/g condition having the highest average weight gain, then the 2.4-mg/g condition, followed by the 15.8-mg/g condition, although only the comparison between the 0.4-mg/g and 15.8-mg/g cigarette conditions was statistically significant (3.10 vs. 1.69 lbs; p = .01). This same graded pattern was evident once again in analyses of "increased appetite/hunger/weight gain" ratings in these two populations, with statistical significance between the lowest and highest doses (2.00 vs. 1.76; p = .02). Among smokers with OUD, there was no effect of cigarette dose or time on weight or subjective "increased appetite/hunger/weight gain." Discussion: Consistent with prior observations in the general population of smokers, smokers with affective disorders and disadvantaged women gained weight when smoking VLNCs. However, the amount of weight gained does not meet a commonly accepted definition of clinically significant weight change (i.e., > 5% baseline weight). Subjective appetite/weight gain also increased, but remained at an overall low level. These findings are reassuring and suggest few, if any, adverse consequences of implementing a nicotine reduction policy with regard to weight.