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Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: A randomized cross‐over study

Keller‐Hamilton, Brittney, Alalwan, Mahmood A., Curran, Hayley, Hinton, Alice, Long, Lauren, Chrzan, Kirsten, Wagener, Theodore L., Atkinson, Leanne +2 more·2024·Addiction
DOI 10.1111/add.16355
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Abstract

Background and aims: Oral nicotine pouches (ONPs) probably offer reduced harm compared with cigarettes, but independent data concerning their misuse liability are lacking. We compared nicotine delivery and craving relief from ONPs with different nicotine concentrations to cigarettes. Design: This was a single‐blind, three‐visit (≥ 48‐hour washout), randomized‐cross‐over study. Participants were encouraged to complete all study visits in less than 1 month. Setting: The study took place in Rural/Appalachian Ohio. Participants: Participants comprised 30 adults who smoke cigarettes. Participants (mean age = 34.5) were 60% men and 90% White. Intervention: Participants who were ≥ 12‐hour tobacco‐abstinent used: (1) a 3‐mg nicotine concentration ONP, (2) a 6‐mg nicotine concentration ONP and (3) usual brand cigarette in separate visits. ONPs (wintergreen Zyn) were used for 30 minutes; cigarettes were puffed every 30 sec for 5 minutes. Measurements: Plasma nicotine and self‐reported craving were assessed at t = 0, 5, 15, 30, 60 and 90 minutes. The primary outcome was plasma nicotine concentration at t = 30 minutes. A secondary outcome was craving relief at t = 5 minutes. Findings: At t = 30, mean [95% confidence interval (CI)] plasma nicotine was 9.5 ng/ml (95% CI = 7.1, 11.9 ng/ml) for the 3 mg nicotine ONP, 17.5 ng/ml (95% CI = 13.7, 21.3) for the 6 mg nicotine ONP and 11.4 ng/ml (95% CI = 9.2, 13.6 ng/ml) for the cigarette. Mean plasma nicotine at t = 30 minutes differed between the 3‐ and 6‐mg nicotine ONPs ( P = 0.001) and between the 6‐mg nicotine ONP and cigarette ( P = 0.002). Mean (95% CI) craving at t = 5 minutes was lower for the cigarette (mean = 1.00, 95% CI = 0.61, 1.39) than either the 3 mg (mean = 2.25, 95% CI = 1.68, 2.82; P < 0.0001) or 6 mg nicotine (mean = 2.19, 95% CI = 1.60, 2.79; P < 0.0001) ONP. Conclusions: Among adult smokers, using 6‐mg nicotine concentration oral nicotine pouches (ONPs) was associated with greater plasma nicotine delivery at 30 minutes than 3‐mg ONPs or cigarettes, but neither ONP relieved craving symptoms at 5 minutes as strongly as a cigarette. Accelerating the speed of nicotine delivery in ONPs might increase their misuse liability relative to cigarettes.

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  • There is higher mean craving at 5 min for smoking after use of 3 mg and 6 mg nicotine ONP compared to conventional cigarettes.

    “Higher mean craving at 5 min for smoking after use of 3 mg and 6 mg nicotine ONP (mean = 2.25; 95% CI: 1.68,-2.82;p < 0.0001 for 3 mg nicotine ONP and mean = 2.19; 95% CI: 1.60-2.79;p < 0.0001 for 6 mg nicotine ONP) compared to CC (mean = 1.00; 95% CI: 0.61-1.39)(Keller-Hamilton et al. 2024)”

    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 Keller-Hamilton et al. 2024

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Cited by

Sorted by citations

Authors
Keller‐Hamilton, B., Alalwan, M. A., Curran, H., Hinton, A., Long, L., Chrzan, K., Wagener, T. L., Atkinson, L., Suraapaneni, S., & Mays, D.
Venue
Addiction
Publisher
Wiley
Published
2023-11-14
Volume
119
Issue
3
Pages
464-475
ISSN
  • 0965-2140
  • 1360-0443
DOI
10.1111/add.16355
Cited by
28
References
4
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (vor)
Funders
  • National Cancer Institute (U54CA287392)
  • National Institute on Drug Abuse (K01DA055696)

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