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A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure

Meier, Ellen, Lindgren, Bruce R, Anderson, Amanda, Reisinger, Sarah A, Norton, Kaila J, Jensen, Joni, Strayer, Lori, Dick, Laura +10 more·2020·Nicotine & Tobacco Research
DOI 10.1093/ntr/ntz055
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Abstract

Introduction: This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents. Method: US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; “use snus as you like with your cigarettes”), (2) complete substitution (CS; “avoid cigarettes”), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers). Results: Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N′-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups. Conclusions: Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents. Implications: Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.

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  • Complete switching to snus for 8 weeks reduces cigarettes per day from 15 to 1.5 (p < 0.001) compared to partial switching or continuing conventional cigarette smoking.

    “Reduce in cigarettes per day (CPD) after complete switching to snus for 8 weeks (from 15 to 1.5; p < 0.001) compared to partial switching (from 14.7 to 11.7; p = 0.02) or continuing CC smoking (from 14.1 to 15.6; p = 0.02) (Meier et al. 2019)”

    From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Meier et al. 2019

  • Complete and partial switching to snus increases snus per day use and increases smoke-free days (p = 0.02 and p < 0.001, respectively).

    “Increase in snus per day (SPD) use after complete and partial switching to snus (from 0 to 7.1 for complete and from 0 to 4.6 for partial Switching to snus; p = 0.02), as well as more smoke-free days (median = 14.5 for complete switching to snus, median = 0 for partial switching to snus and continuing CC smoking; p < 0.001)”

    From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Meier et al. 2019

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Cited by

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Authors
Meier, E., Lindgren, B. R., Anderson, A., Reisinger, S. A., Norton, K. J., Jensen, J., Strayer, L., Dick, L., Tang, M.-K., Chen, M., Carmella, S. G., Hecht, S. S., Murphy, S. E., Yang, J., Stepanov, I., O’Connor, R. J., Shields, P. G., & Hatsukami, D. K.
Venue
Nicotine & Tobacco Research
Publisher
Oxford University Press (OUP)
Published
2019-04-11
Volume
22
Issue
4
Pages
473-481
ISSN
  • 1462-2203
  • 1469-994X
DOI
10.1093/ntr/ntz055
Cited by
11
References
1
Language
en
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Funders
  • National Cancer Institute (U19CA157345)
  • National Center for Advancing Translational Sciences (UL1 TR000062)
  • National Institutes of Health
  • National Institute on Drug Abuse (T32 DA007097)

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