{"doi":"10.1093/ntr/ntac231","title":"Immediate Switching to Reduced Nicotine Cigarettes in a U.S.-Based Sample: The Impact on Cannabis Use and Related Variables at 20 Weeks","abstract":"INTRODUCTION: The FDA proposed rule-making to reduce nicotine in cigarettes to minimally addictive levels. Research suggests decreasing nicotine levels (i.e. very low nicotine content cigarettes [VLNCs]) produced greater quit attempts, reduced smoking, and reduced exposure to harmful constituents among smokers. The impact of long-term VLNC use among people who co-use cigarettes and cannabis on non-tobacco-specific toxicant and carcinogen exposure has not been investigated. AIMS AND METHODS: This study presents secondary analyses of a controlled clinical trial examining switching to VLNC (versus a normal nicotine cigarettes control group [NNCs]) between people who co-use cigarettes and cannabis (n = 174) versus smoked cigarettes (n = 555). Linear mixed-effects models compared changes in smoking behavior, and tobacco-specific (i.e. total nicotine equivalents [TNE], 4-[methylnitrosamino]-1-[3-pyridyl]-1-butanone [NNK; total NNAL]) and non-tobacco-specific (i.e. carbon monoxide (CO), 2-cyanoethylmercapturic acid [CEMA], phenanthrene tetraol [PheT]) toxicant and carcinogen exposure at week 20 (with random intercept for participants). Cannabis use was measured among co-use groups. RESULTS: CO was significantly lower only among the cigarette-only group assigned VLNCs (interaction: p = .015). Although both VLNC groups demonstrated decreased CEMA, greater decreases emerged among the cigarette-only group (interaction: p = .016). No significant interactions emerged for TNE, cigarettes per day (CPD), NNAL, and PheT (ps > .05); both VLNC groups decreased in TNE, CPD, and NNAL. Only the cigarette-only group assigned VLNCs demonstrated decreased PheT (p < .001). The VLNC co-use group showed increased cannabis use over time (p = .012; 0.5 more days per week by week 20). CONCLUSIONS: Those who co-use cannabis and cigarettes may still be at risk for greater exposure to non-tobacco-specific toxicants and carcinogens compared to those who only smoke cigarettes. IMPLICATIONS: The present study is the longest longitudinal, prospective comparison study of smoking behavior and exposure to harmful constituents among those who co-use cigarettes and cannabis versus cigarette-only after immediately switching to very low nicotine content cigarettes (VLNC). Those who co-use experienced similar reductions in CPD and tobacco-specific exposure, compared to those who only use cigarettes. However, co-use groups experienced smaller reductions in non-tobacco-specific toxicants and carcinogens compared to the cigarette-only group, potentially because of combustible cannabis use. Additionally, those who co-use and switched to VLNC may be susceptible to slight increases in cannabis use (approximately two more days per year).","journal":"Nicotine & Tobacco Research","year":2022,"id":286781,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9515,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":334865,"name":"Nathan Rubin","orcid":"0000-0001-7162-5225","position":1,"is_corresponding":false},{"id":403932,"name":"Sarah S. Dermody","orcid":"0000-0003-4998-6803","position":2,"is_corresponding":false},{"id":392775,"name":"Katelyn Tessier","orcid":"0000-0002-5513-583X","position":3,"is_corresponding":false},{"id":25149,"name":"Stephen S. Hecht","orcid":"0000-0001-7228-1356","position":4,"is_corresponding":false},{"id":368395,"name":"Sharon E. Murphy","orcid":"0000-0001-5391-8104","position":5,"is_corresponding":false},{"id":370076,"name":"Joni Jensen","orcid":null,"position":6,"is_corresponding":false},{"id":414599,"name":"Eric C. Donny","orcid":"0000-0003-3288-9652","position":7,"is_corresponding":false},{"id":393050,"name":"Mustafa Al’Absi","orcid":"0000-0003-4531-038X","position":8,"is_corresponding":false},{"id":453818,"name":"David J. Drobes","orcid":null,"position":9,"is_corresponding":false},{"id":966500,"name":"Joe Koopmeiners","orcid":null,"position":10,"is_corresponding":false},{"id":403931,"name":"Rachel Denlinger-Apte","orcid":"0000-0002-3182-7188","position":11,"is_corresponding":false},{"id":307143,"name":"Jennifer W. Tidey","orcid":"0000-0002-8651-4947","position":12,"is_corresponding":false},{"id":452729,"name":"Ryan G. Vandrey","orcid":"0000-0001-6657-884X","position":13,"is_corresponding":false},{"id":966501,"name":"Cole Thorne","orcid":null,"position":14,"is_corresponding":false},{"id":252495,"name":"Dorothy K. Hatsukami","orcid":"0000-0002-1108-2609","position":15,"is_corresponding":false},{"id":453817,"name":"Ellen Meier","orcid":null,"position":0,"is_corresponding":true}],"reference_count":24,"raw_metadata":null,"created_at":"2026-07-19T00:29:52.825777Z","pmid":"36198098","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}