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Impact of Nicotine Reduction on Adolescent Cigarette Use, Alternative Tobacco Use, and Harm From Tobacco (SIREN)

Primary Purpose

Nicotine Dependence, Cigarettes, Uncomplicated

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Very Low Nicotine Content Cigarettes
Normal Nicotine Content Cigarettes
Sponsored by
Brown University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Nicotine Dependence, Cigarettes, Uncomplicated

Eligibility Criteria

15 Years - 19 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • 1) Ages 15-20 inclusive 2) Male and female current daily smokers

    1. Defined as self-reported daily cigarette smoking at phone screening AND
    2. a breath carbon monoxide (CO) criterion of 5 ppm or higher; if this is not met, urine cotinine levels, detected by a NicAlert cotinine screening device, must indicate recent smoking (level 3 or higher) 3) Current users of alternative tobacco product(s)

    a. Defined as any self-reported use of at least one non-cigarette tobacco product (e.g., e-cigarettes, little cigars, cigarillos, hookah, etc.) in the past 30 days 4) Participants must speak and comprehend English well enough to complete study procedures.

    a. Participant will be asked to read aloud first few lines of informed consent and then summarize the contents aloud to check for competency 5) Participants under 18 must provide assent and parental consent from a parent/guardian.

    a. Participants age 18 or 19 may provide their own written consent contingent on photo ID verification of age.

Exclusion Criteria:

  • 1) Unwilling to use research cigarettes as part of the study 2) Self-reported daily drinking of alcohol or use of illicit or non-prescribed drugs (excluding marijuana) > 10 days in the past 30 days

    a. We will ask about daily alcohol and drug use in the phone screen, and we will use the Timeline Follow-Back to assess current and recent marijuana and alcohol use.

    3) Currently seeking treatment to quit smoking, and/or intending to quit smoking for good in the next 30 days

    1. This information corresponds to questions 2 & 3 of the Stages of Change measure which will be administered at the in-person screening.
    2. These participants will be excluded, and provided with referral information for cessation services in the community.

      4) Suicidal ideation in the past month or any past-year suicide attempts

    a. Suicidal ideation determined by the MINI ( Mini International Neuropsychiatric Interview) suicide subscale at the in-person screening (Questions 4 and 5) b. Suicide attempt in the past year determined by MINI question 6.a. (If participant has a lifetime history of suicide attempt between 1 and 10 years ago, licensed medical monitor approval required) c. If a participant indicates that he/she currently has suicidal ideation during this or any future session, the Emergency Protocol will be followed in which a Licensed Clinician will be contacted immediately, and participants will speak with the clinician over the phone and the clinician will determine the appropriate action to take to keep the child safe.

    5) Pregnant or breastfeeding

    a. Determined by urine test at in-person screening; tested again at each in-person visit; participant will be excluded or withdrawn if test indicates pregnancy b. Self-reports current breastfeeding at in-person screening 6) Any medical or psychiatric conditions in which participation is likely to pose a significant threat to health or for which the condition could interfere with the ability of the participant to fully participate (as determined by LMP).

    7) Having participated in another research study during the past year in which they were switched to research cigarettes for longer than one week.

Sites / Locations

  • Brown University School of Public Health

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Very Low Nicotine Content Cigarettes

Normal Nicotine Content Cigarettes

Arm Description

Outcomes

Primary Outcome Measures

Cigarettes smoked per day
Total Amount of Alternative Product Use

Secondary Outcome Measures

Amount of combustible and noncombustible alternative product use
Number of Study Cigarettes
Toxicant Exposure
Total Nicotine Equivalents, cotinine, and/or tobacco-specific carcinogens
Respiratory outcomes
Forced Expiratory Volume (FEV) Outcomes

Full Information

First Posted
February 15, 2019
Last Updated
November 3, 2022
Sponsor
Brown University
Collaborators
National Institute on Drug Abuse (NIDA)
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1. Study Identification

Unique Protocol Identification Number
NCT03860077
Brief Title
Impact of Nicotine Reduction on Adolescent Cigarette Use, Alternative Tobacco Use, and Harm From Tobacco
Acronym
SIREN
Official Title
Impact of Nicotine Reduction on Adolescent Cigarette Use, Alternative Tobacco Use, and Harm From Tobacco
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
October 10, 2019 (Actual)
Primary Completion Date
March 23, 2022 (Actual)
Study Completion Date
March 23, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Brown University
Collaborators
National Institute on Drug Abuse (NIDA)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Adolescents are an important vulnerable population to consider as the FDA moves toward a nicotine reduction policy. Such a policy, which would mandate a reduction of nicotine in all commercially available cigarettes, has the potential to transform public health and greatly reduce the toll of tobacco-related death and disease. Yet, data on the effects of such a policy on cigarette use among adolescents are lacking. Further, the advent of e-cigarettes and the popularity of alternative tobacco products have fundamentally altered the current landscape of nicotine delivery, and these products are widely used by adolescents. Although adolescent cigarette use is at an all-time low in the U.S., this reduction has been mirrored by an increase in e-cigarette use, and multiple tobacco product (MTP) use is the most common pattern of use in youth. Adolescent MTP users are more likely to be dependent on nicotine and to have begun using tobacco earlier than their single-product using peers. Thus, MTP-using youth differ from youth who solely smoke cigarettes in meaningful ways that have implications for responses to a nicotine reduction regulatory policy. In adults, longer-term studies have demonstrated that very low nicotine content (VLNC) cigarette exposure results in fewer cigarettes smoked and reduced toxicant exposure; however, increased use of alternative tobacco products has also been reported. No studies to date have examined the effects of VLNC cigarettes on MTP use or toxicant exposure in youth. This study will use real-time, smartphone-based ecological momentary assessment (EMA) and laboratory-based assessments to: (1) investigate the effects of cigarette nicotine reduction on cigarette and MTP use, (2) assess the influence of cigarette nicotine reduction on the harms associated with tobacco use, including nicotine and toxicant exposure, respiratory symptoms, perceived health risk and nicotine dependence, and (3) use a combination of laboratory and real-time assessment to investigate the effects of nicotine reduction on changes in withdrawal, craving, and the reinforcing efficacy of cigarettes to characterize the mechanisms by which VLNC use may affect behavior. Overall, this project will help determine the effects of VLNC cigarettes on real-world tobacco use behavior and indices of tobacco-related harm in adolescents, and examining the mechanisms through which nicotine reduction in cigarettes may effect such changes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nicotine Dependence, Cigarettes, Uncomplicated

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
57 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Very Low Nicotine Content Cigarettes
Arm Type
Experimental
Arm Title
Normal Nicotine Content Cigarettes
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Very Low Nicotine Content Cigarettes
Intervention Description
Very Low Nicotine Content Cigarettes
Intervention Type
Drug
Intervention Name(s)
Normal Nicotine Content Cigarettes
Intervention Description
Normal Nicotine Content Cigarettes
Primary Outcome Measure Information:
Title
Cigarettes smoked per day
Time Frame
Baseline-Week 4
Title
Total Amount of Alternative Product Use
Time Frame
Baseline-Week 4
Secondary Outcome Measure Information:
Title
Amount of combustible and noncombustible alternative product use
Time Frame
Baseline-Week 4
Title
Number of Study Cigarettes
Time Frame
Baseline-Week 4
Title
Toxicant Exposure
Description
Total Nicotine Equivalents, cotinine, and/or tobacco-specific carcinogens
Time Frame
Baseline-Week 4
Title
Respiratory outcomes
Description
Forced Expiratory Volume (FEV) Outcomes
Time Frame
Baseline-Week 4
Other Pre-specified Outcome Measures:
Title
American Thoracic Society Questionnaire
Description
Respiratory Health Symptoms; an 8-item questionnaire measuring frequency of experience respiratory symptoms; scores can range from 8 to 40 and greater scores indicate greater frequency.
Time Frame
Baseline-Week 4
Title
Perceived health risk questionnaire
Description
Perceived risk for developing diseases associated with use study cigarettes and usual brand cigarettes; Scores range from 1 (much less risk) to 5 (much greater risk) for each disease
Time Frame
Baseline-Week 4
Title
Nicotine dependence
Description
Modified Fagerstrom Tolerance Questionnaire (mFTQ) score; Scale 2-8, higher scores indicate greater nicotine dependence
Time Frame
Baseline-Week 4
Title
Craving
Description
Questionnaire on Smoking Urges (QSU) post- smoking in the laboratory, a 10 item scale that is comprised of 2 factors; Factor 1 included items 1, 3, 6, 7, and 10 Factor 2 included items 2, 4, 5, 8, and 9 The score for each factor is calculated by summing the item scores; the total score is calculated by summing all 10 items. A single-item craving question (ranging from 1-10, not all to greatly) from daily random and post-event Ecological Momentary Assessments.
Time Frame
Baseline-Week 4
Title
Withdrawal
Description
Minnesota Nicotine Withdrawal Scale 7-item version; greater score indicates greater withdrawal
Time Frame
Baseline-Week 4
Title
Subjective Response to Cigarettes
Description
Cigarette Evaluation Scale post-smoking in the laboratory; 5 subscales are derived from this scale: Psychological Reward, Smoking Satisfaction, Enjoyment of Respiratory Sensations, Craving Reduction; Aversion. Event level on satisfaction derived from post-use responses on daily Ecological Momentary Assessments.
Time Frame
Baseline-Week 4
Title
Hypothetical Purchasing of Cigarettes
Description
Cigarette Purchase Task; Five indices of demand for cigarettes are derived from this measure (Intensity, Omax, Breakpoint, Pmax, Alpha)
Time Frame
Baseline-Week 4
Title
Hypothetical Purchasing of Tobacco Products
Description
Purchasing of cigarettes and other tobacco products across changing prices in Experimental Tobacco Marketplace task
Time Frame
Baseline-Week 4

10. Eligibility

Sex
All
Minimum Age & Unit of Time
15 Years
Maximum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: 1) Ages 15-20 inclusive 2) Male and female current daily smokers Defined as self-reported daily cigarette smoking at phone screening AND a breath carbon monoxide (CO) criterion of 5 ppm or higher; if this is not met, urine cotinine levels, detected by a NicAlert cotinine screening device, must indicate recent smoking (level 3 or higher) 3) Current users of alternative tobacco product(s) a. Defined as any self-reported use of at least one non-cigarette tobacco product (e.g., e-cigarettes, little cigars, cigarillos, hookah, etc.) in the past 30 days 4) Participants must speak and comprehend English well enough to complete study procedures. a. Participant will be asked to read aloud first few lines of informed consent and then summarize the contents aloud to check for competency 5) Participants under 18 must provide assent and parental consent from a parent/guardian. a. Participants age 18 or 19 may provide their own written consent contingent on photo ID verification of age. Exclusion Criteria: 1) Unwilling to use research cigarettes as part of the study 2) Self-reported daily drinking of alcohol or use of illicit or non-prescribed drugs (excluding marijuana) > 10 days in the past 30 days a. We will ask about daily alcohol and drug use in the phone screen, and we will use the Timeline Follow-Back to assess current and recent marijuana and alcohol use. 3) Currently seeking treatment to quit smoking, and/or intending to quit smoking for good in the next 30 days This information corresponds to questions 2 & 3 of the Stages of Change measure which will be administered at the in-person screening. These participants will be excluded, and provided with referral information for cessation services in the community. 4) Suicidal ideation in the past month or any past-year suicide attempts a. Suicidal ideation determined by the MINI ( Mini International Neuropsychiatric Interview) suicide subscale at the in-person screening (Questions 4 and 5) b. Suicide attempt in the past year determined by MINI question 6.a. (If participant has a lifetime history of suicide attempt between 1 and 10 years ago, licensed medical monitor approval required) c. If a participant indicates that he/she currently has suicidal ideation during this or any future session, the Emergency Protocol will be followed in which a Licensed Clinician will be contacted immediately, and participants will speak with the clinician over the phone and the clinician will determine the appropriate action to take to keep the child safe. 5) Pregnant or breastfeeding a. Determined by urine test at in-person screening; tested again at each in-person visit; participant will be excluded or withdrawn if test indicates pregnancy b. Self-reports current breastfeeding at in-person screening 6) Any medical or psychiatric conditions in which participation is likely to pose a significant threat to health or for which the condition could interfere with the ability of the participant to fully participate (as determined by LMP). 7) Having participated in another research study during the past year in which they were switched to research cigarettes for longer than one week.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rachel Cassidy, PhD
Organizational Affiliation
Brown University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Brown University School of Public Health
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02912
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
The investigators involved in this project intend to share findings from its research through publications and presentations. After all data have been collected and the results of the study have been published, de-identified data will be made available to other qualified investigators upon request. Institutions and/or individuals wishing to access any resources or data must contact the Principal Investigators. Persons requesting data must do so in writing, identifying their affiliation and how and by whom the data will be used. The request will be evaluated by the PIs and Co-Investigators to ensure that it meets reasonable demands of scientific integrity.

Learn more about this trial

Impact of Nicotine Reduction on Adolescent Cigarette Use, Alternative Tobacco Use, and Harm From Tobacco

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