Tobacco Control Tūranga Update Focus on reducing nicotine content in tobacco to help smokers quit

Transcription

1 Tobacco Control Tūranga Update Focus on reducing nicotine content in tobacco to help smokers quit Professor Chris Bullen and Dr Marewa Glover, Co-Directors, Tobacco Control Research Turanga 18 March 2015

2 The Tūranga brief Innovative Interventions focused Rapid turnaround Multi-institution, multi-disciplinary collaboration Strongly linked to information needs of end users Inform rapid prevalence reduction overall but also in priority population groups Ability to be scaled up

3 Source: BODE3 2014

4 New projects, last funding round 15 projects supported, 4 underway Developing and testing a computer model and visualisation of personalised lung dysfunction due to smoking with feedback to smokers to motivate quitting. Developing and testing a portable smoke sensor system (for SHS and THS) that alerts smokers to hazards of smoking as an incentive to quit. Testing a vision-based system for detecting anxiety and craving in smokers (with feedback). Testing a 3-D Fetus computer model with its ultrasound image to increase the motivation of pregnant women who smoke to quit.

5 NICOTINE REDUCTION STUDY Dr Natalie Walker, Dr Murray Laugesen, Dr Penny Truman, Trish Fraser, Prof Chris Bullen, Dr Marewa Glover Single blind pilot RCT that explored smoking behaviour of 33 smokers not wanting to quit 12 weeks supply of free de-nicotinised cigarettes vs. usual smoking No support in either group

6 Nicotine reduction 85% of smokers in New Zealand want the addictiveness of cigarettes reduced [Edwards et al. NZ Med J. 2009] Maori Affairs Committee Inquiry into tobacco industry recommended government reduce nicotine content of tobacco Early reduced nicotine cigarette brands 1970s: light and mild descriptors By blocking holes and/or changing puff rate and/or intensity the smoker could increase nicotine intake beyond stated machine yield = compensatory smoking

7 Cigarettes used 22 nd Century Very low nicotine content cigarettes (VLNC) Magic brand Nicotine content: 1.8 mg per cigarette Nicotine yield: 0.04 mg per cigarette Tar content: 4.1 mg per cigarette

8 Compared to smokers who smoke regular cigarettes, will smokers offered cheaper VLNC cigarettes - reduce the number of regular cigarettes they smoke? what will the mix of regular and VLNC cigarettes look like? make more quit attempts, or be more likely to quit? have reduced measures of addiction? like the concept of a nicotine reduction strategy?

9 Registered: N = 54 Randomised: N = 33 Intervention N=17 Control N=16 Ineligible: n = 18 Smoke RYO: n = 5 No consent: n = 5 Plan to quit: n=2 Not daily: n=2 30 mins waking: n=2 No mobile: n=1 Outside region: n=1 Excluded after run-in (n=3) Non complaint: n=1 Withdrew: n=1 No reason: n=1 6 weeks N=17 6 weeks N=15 12 weeks N=17, LTFU= 0% 12 weeks N=15, LTFU=6%

10 Baseline Intervention N=17 (%) Control N=16 (%) Overall N=33 (%) Sex Female 11 (65) 7 (44) 18 (55) Age (yrs) Mean SD Ethnicity Māori Non-Māori Education < year 12 year (12) 15 (88) 7 (41) 10 (59) (6) 15 (94) 5 (31) 11 (69) (9) 30 (91) 12 (36) 22 (64) SD = Standard deviation

11 Baseline smoking history Intervention N=17 (%) Control N=16 (%) Overall N=33 (%) Type of tobacco Factory made only Both factory & RYO 11 (65) 6 (35) 7 (44) 9 (56) 18 (55) 15 (45) Yrs smoked continuously Mean SD Age started smoking (yrs) Mean SD Number of regular cpd Mean SD Only one person (control) had made a quit attempt in the last 3 months, and they used hypnotherapy SD = Standard deviation RYO = Roll your own cigarettes CPD = cigarettes smoked per day

12 Dependence: Time to first regular cigarette Six weeks 12 weeks

13 Glover Nilsson Smoking Behavioural questionnaire < 12 = mild behavioural dependence = moderate behavioural dependence = strong behavioural dependence >33 = very strong behavioural dependence Change from baseline to 12 weeks (T-test): p= No difference at 6 weeks

14 Autonomy over smoking (AUTOS) Change from baseline and 12 weeks (t-test): Withdrawal: p= Craving: p= Dependence= Total: p= 0.078

15 Quit attempts How many quit attempts (defined as having stopped for 24 hrs) have you made since your baseline visit? At six weeks Six in intervention group One in control group At 12 weeks Seven in intervention group One in control group

16 Have you quit smoking since your baseline visit? At Six Weeks At 12 Weeks 7 day point prevalence 1 in intervention 0 in control 2 in intervention 0 in control Continuous abstinence 2 in intervention 1 in control 2 in intervention 1 in control

17 Salivary cotinine Cotinine

18 Views on nicotine reduction Imagine cigarettes low in nicotine were on the market. Would you be more likely to buy them instead of your regular brand, if they were. Same price $1 cheaper $10 cheaper

19 Conclusions A price differential based on nicotine content of tobacco can lead to a reduction in addiction and smoking dependency and an increase in quitting behaviour. BUT Dual use of product will occur (a balance of craving and cost) to maintain same smoking pattern The price differential would need to be substantial Therefore.

20 Policy implication An immediate and significant reduction to a low nicotine level is required Nicotine yield: 0.05 mg per cigarette Nicotine content: <2.0 mg per cigarette Need to monitor VLNC cigarette design and additives

21 NICOTINE AVAILIBILITY Addiction Threshold YEARS Remove regular tobacco completely, ie only VLNC cigarettes on the market

22 The Tūranga is supported through the Reducing Tobacco-related Harm Research Partnership co-funded by the Health Research Council of New Zealand and the Ministry of Health (HRC grant 11/818) Follow the Tūranga: Tobacco Control Research Turanga