E-cigarette nicotine dose and flavor: Relationship with appeal, choice, and tobacco use amongst veterans with comorbid psychiatric disorders.

Abstract

BACKGROUND\nElectronic cigarettes (EC) may aid some smokers in reducing combustible tobacco use. Smokers with psychiatric co-morbidities tend to have higher nicotine dependence and worse outcomes, so may particularly benefit from alternative cessation aids. EC characteristics, like nicotine level and flavor, may influence EC s appeal to smokers. Nicotine level may impact EC s efficacy in reducing combustible cigarette use.\n\n\nMETHODS\nNon-treatment-seeking cigarette smokers with medical/psychiatric co-morbidities rated liking of ECs varying in nicotine level (12\u202fmg, 24\u202fmg) and flavor (menthol, slim -tobacco, burley -tobacco), during an open-label Choice Procedure. Smokers (N\u202f=\u202f43) chose ECs for a 4-week take-home-trial, and used EC and/or combustible cigarettes as they wished. Analyses examined ratings and choice by nicotine level and flavor, and the relationship between consistent take-home choice of 12\u202fmg versus 24\u202fmg baseline demographic/smoking characteristics, and outcomes (cigarettes/day, nicotine intake, motivation to quit smoking) during take-home-trial and one-month follow-up.\n\n\nRESULTS\nSmokers who chose menthol-flavor, tobacco-flavor and/or 24\u202fmg nicotine e-liquids for the first take-home week rated these conditions as more liked than alternative options, at baseline. Groups who chose 12\u202fmg versus 24\u202fmg throughout the take-home trial did not significantly differ on baseline characteristics, or smoking-related outcomes within the take-home trial, however, motivation to quit smoking increased more from baseline to one-month follow-up in choosers of higher nicotine (24\u202fmg) ECs.\n\n\nCONCLUSIONS\nAssociations between subjective ratings and subsequent choice support feasibility of open-label choice-procedures in EC trials. Access to 12\u202fmg or 24\u202fmg nicotine ECs was associated with reduced smoking, and 24\u202fmg ECs with increased motivation to quit smoking in smokers with medical/psychiatric co-morbidities.