A Study of Unfiltered Cigarettes Among Committed Smokers

Cigarette Smoking Clinical Trial

Official title:

A Randomized Cross-over Clinical Trial of Unfiltered Cigarettes

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03749876
• Other study ID #: TRDRP Award #580582
• Status: Completed
• Phase: N/A
• Start date: January 17, 2019
• Est. completion date: June 30, 2020

Study information

• Verified date: October 2020
• Source: San Diego State University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is an open-label, randomized, 9-week, two-sequence, two-treatment, cross-over clinical trial of 40 adult filtered cigarette smokers who switch to unfiltered cigarettes There will be a 1-week baseline period, 2 weeks of smoking filtered or unfiltered cigarettes (determined at time of randomization), and a 3-week washout period, followed by post-washout baseline week, and a crossover to 2 weeks of smoking the opposite condition.

Description:

This innovative research project will assess the acceptability among committed smokers of switching to unfiltered cigarettes from filtered cigarettes and compare the measurement of exposure to nicotine and carcinogens after such a switch from filtered to unfiltered cigarettes. Such research will inform regulatory policy regarding the possibility of banning filters from the U.S. cigarette market. This high-impact pilot project is a randomized, cross-over clinical trial among smokers to measure changes in their puffing behavior, carcinogen exposures, nicotine exposure, and attitudes toward smoking unfiltered cigarettes if they were to no longer able to buy filtered cigarettes. The overall objective for this pilot trial is to collect preliminary data to inform design of a larger clinical trial in assessing changes in attitudes toward smoking unfiltered cigarettes; smoking topography; and urinary cotinine, urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and volatile organic compound (VOC) excretion resulting from switching from filtered to unfiltered cigarettes among a sample of committed smokers. Aim 1. Determine smokers' satisfaction, and attitudes towards smoking cigarettes if they were to switch from smoking filtered to unfiltered cigarettes. The investigators hypothesize that smokers who smoke unfiltered cigarettes will have less satisfaction with their smoking compared with smoking filtered cigarettes. Aim 2. Measure changes in smoking topography and cigarettes smoked per day among smokers who change to unfiltered cigarettes for two weeks compared with these measures while smoking filtered cigarettes. The investigators hypothesize that smokers who smoke unfiltered cigarettes for two weeks will change their topography such that they will inhale less deeply and frequently and will smoke fewer cigarettes per day. Aim 3. Measure changes in urinary cotinine, NNAL, and VOC excretion among smokers who smoke unfiltered cigarettes for two weeks compared to smoking filtered cigarettes. The investigators hypothesize that smokers who smoke unfiltered cigarettes for two weeks will have lower urinary cotinine, NNAL, and VOC excretion compared with filtered cigarettes. The results from this trial can inform a larger clinical trial that can be submitted to the National Institutes of Health/Food and Drug Administration to develop evidence on the potentially positive impact of removing plastic filters from commercial cigarettes. It will allow us to develop sound scientific methods to assess the topography of smoking and excretion of cotinine, tobacco-specific nitrosamines, and VOCs by smokers who smoke cigarettes with and without filters. This new knowledge may lead the Food and Drug Administration or specific states to consider banning the sale of filtered cigarettes because filters make it easier for young people to start smoking, unjustifiably discourage smokers from quitting, and contaminate the environment with non-biodegradable, toxic waste.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 37
• Est. completion date: June 30, 2020
• Est. primary completion date: June 30, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 21 Years to 65 Years

Eligibility

Inclusion Criteria:

• Are non-institutionalized, and
• Able to provide informed consent, and
• Are ages 21 to 65, and
• Smoke at least 25 days per month, and
• Smoke at least 5 cigarettes per day on the days they smoke, and
• Have been smoking cigarettes for at least 1 year, and
• Have smoked exclusively Camel or Pall Mall cigarettes over the past two weeks, or are willing to do so for the two weeks prior to, and for seven weeks during, the study, and
• Are fluent in English, and
• Have regular access to a telephone, and
• Have smoked only filtered cigarettes for the past year, and
• Have access to transportation to California State University, San Marcos (CSUSM), and
• Report primary (=50% of the time) smoking of cigarettes, allowing for secondary use of other tobacco products, and
• Agree to the terms of the trial

Exclusion Criteria:

• Do not meet one or more of the above inclusion criteria, or
• Self-report uncontrolled diabetes (i.e., diagnosed with diabetes, and it is not being managed by a physician), or
• Present to the enrollment visit with a systolic blood pressure greater than 160 mm Hg or a diastolic blood pressure greater than 105 mm Hg, or
• Self-report involvement in another clinical trial, or
• Self-report hospitalization for psychiatric issues or had a heart-related event (e.g. heart attack) at enrollment or within the past 30 days, or
• Self-report attempts to quit or cut down on smoking in past 30 days, or
• Self-report use of pharmacotherapy to aid smoking cessation within the past 30 days, or
• Are breastfeeding, pregnant, or may become pregnant during the next six months, or
• Are planning to move out of San Diego in the next 9 weeks, or
• Do not meet expected expired carbon monoxide (CO) measurements of smokers (Expired CO measurements>10 parts per million (ppm) will confirm status as a current smoker of at >5 cigarettes/day on the initial visit), or
• Are deemed mentally unstable (i.e., psychotic, under influence of drugs or alcohol, or unable to comprehend the call or meeting) or physically unfit (i.e, physically unwell) to participate in the study based on the researcher's determination at the enrollment visit

Related Conditions & MeSH terms

• Cigarette Smoking
• Tobacco Smoking

Intervention

Other:
• Unfiltered Cigarettes
Participants will be given unfiltered Pall Mall or Camel cigarettes to smoke for two weeks according to the brand they smoked prior to the start of the study. They will agree to smoke the cigarettes using a monitoring device (CReSS) that measures puffing behavior on five (5) days during each of the two weeks. They will also collect their cigarette butts on all days as a measure of smoking behaviors.
• Filtered Cigarettes
Participants will be given filtered Pall Mall or Camel cigarettes to smoke for two weeks according to the brand they smoked prior to the start of the study. They will agree to smoke the cigarettes using a monitoring device (CReSS) that measures puffing behavior on five (5) days during each of the two weeks. They will also collect their cigarette butts on all days as a measure of smoking behaviors.

Locations

Country	Name	City	State
United States	California State University San Marcos	San Marcos	California

Sponsors (3)

Lead Sponsor	Collaborator
San Diego State University	California State University, San Marcos, Tobacco Related Disease Research Program

Country where clinical trial is conducted

United States, 

References & Publications (47)

Benowitz NL, Dains KM, Hall SM, Stewart S, Wilson M, Dempsey D, Jacob P 3rd. Progressive commercial cigarette yield reduction: biochemical exposure and behavioral assessment. Cancer Epidemiol Biomarkers Prev. 2009 Mar;18(3):876-83. doi: 10.1158/1055-9965.EPI-08-0731. Epub 2009 Mar 3. — View Citation

Benowitz NL, Hall SM, Stewart S, Wilson M, Dempsey D, Jacob P 3rd. Nicotine and carcinogen exposure with smoking of progressively reduced nicotine content cigarette. Cancer Epidemiol Biomarkers Prev. 2007 Nov;16(11):2479-85. — View Citation

Blank MD, Breland AB, Enlow PT, Duncan C, Metzger A, Cobb CO. Measurement of smoking behavior: Comparison of self-reports, returned cigarette butts, and toxicant levels. Exp Clin Psychopharmacol. 2016 Oct;24(5):348-355. Epub 2016 Jun 27. — View Citation

Blank MD, Disharoon S, Eissenberg T. Comparison of methods for measurement of smoking behavior: mouthpiece-based computerized devices versus direct observation. Nicotine Tob Res. 2009 Jul;11(7):896-903. doi: 10.1093/ntr/ntp083. Epub 2009 Jun 11. — View Citation

Brooks DR, Austin JH, Heelan RT, Ginsberg MS, Shin V, Olson SH, Muscat JE, Stellman SD. Influence of type of cigarette on peripheral versus central lung cancer. Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):576-81. — View Citation

Clark PI, Gautam SP, Hlaing WM, Gerson LW. Response error in self-reported current smoking frequency by black and white established smokers. Ann Epidemiol. 1996 Nov;6(6):483-9. — View Citation

Connolly GN, Alpert HR. Has the tobacco industry evaded the FDA's ban on 'Light' cigarette descriptors? Tob Control. 2014 Mar;23(2):140-5. doi: 10.1136/tobaccocontrol-2012-050746. Epub 2013 Mar 13. — View Citation

Cubbin C, Soobader MJ, LeClere FB. The intersection of gender and race/ethnicity in smoking behaviors among menthol and non-menthol smokers in the United States. Addiction. 2010 Dec;105 Suppl 1:32-8. doi: 10.1111/j.1360-0443.2010.03191.x. — View Citation

Czoli CD, Hammond D. Cigarette packaging: Youth perceptions of "natural" cigarettes, filter references, and contraband tobacco. J Adolesc Health. 2014 Jan;54(1):33-9. doi: 10.1016/j.jadohealth.2013.07.016. Epub 2013 Sep 4. — View Citation

Djordjevic MV, Stellman SD, Zang E. Doses of nicotine and lung carcinogens delivered to cigarette smokers. J Natl Cancer Inst. 2000 Jan 19;92(2):106-11. — View Citation

Dodder NG, Tai SS, Sniegoski LT, Zhang NF, Welch MJ. Certification of creatinine in a human serum reference material by GC-MS and LC-MS. Clin Chem. 2007 Sep;53(9):1694-9. Epub 2007 Jul 27. — View Citation

Goniewicz ML, Gawron M, Smith DM, Peng M, Jacob P 3rd, Benowitz NL. Exposure to Nicotine and Selected Toxicants in Cigarette Smokers Who Switched to Electronic Cigarettes: A Longitudinal Within-Subjects Observational Study. Nicotine Tob Res. 2017 Feb;19(2):160-167. doi: 10.1093/ntr/ntw160. Epub 2016 Aug 17. — View Citation

Goniewicz ML, Havel CM, Peng MW, Jacob P 3rd, Dempsey D, Yu L, Zielinska-Danch W, Koszowski B, Czogala J, Sobczak A, Benowitz NL. Elimination kinetics of the tobacco-specific biomarker and lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. Cancer Epidemiol Biomarkers Prev. 2009 Dec;18(12):3421-5. doi: 10.1158/1055-9965.EPI-09-0874. — View Citation

Gust SW, Pickens RW. Does cigarette nicotine yield affect puff volume? Clin Pharmacol Ther. 1982 Oct;32(4):418-22. — View Citation

Hammond D, Fong GT, Cummings KM, O'Connor RJ, Giovino GA, McNeill A. Cigarette yields and human exposure: a comparison of alternative testing regimens. Cancer Epidemiol Biomarkers Prev. 2006 Aug;15(8):1495-501. — View Citation

Harris B. The intractable cigarette 'filter problem'. Tob Control. 2011 May;20 Suppl 1:i10-6. doi: 10.1136/tc.2010.040113. — View Citation

Hastrup JL, Cummings KM, Swedrock T, Hyland A, Pauly JL. Consumers' knowledge and beliefs about the safety of cigarette filters. Tob Control. 2001 Mar;10(1):84. — View Citation

Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991 Sep;86(9):1119-27. — View Citation

Horne DJ, Campo M, Ortiz JR, Oren E, Arentz M, Crothers K, Narita M. Association between smoking and latent tuberculosis in the U.S. population: an analysis of the National Health and Nutrition Examination Survey. PLoS One. 2012;7(11):e49050. doi: 10.1371/journal.pone.0049050. Epub 2012 Nov 8. — View Citation

Ito H, Matsuo K, Tanaka H, Koestler DC, Ombao H, Fulton J, Shibata A, Fujita M, Sugiyama H, Soda M, Sobue T, Mor V. Nonfilter and filter cigarette consumption and the incidence of lung cancer by histological type in Japan and the United States: analysis of 30-year data from population-based cancer registries. Int J Cancer. 2011 Apr 15;128(8):1918-28. doi: 10.1002/ijc.25531. — View Citation

Jacob P 3rd, Havel C, Lee DH, Yu L, Eisner MD, Benowitz NL. Subpicogram per milliliter determination of the tobacco-specific carcinogen metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in human urine using liquid chromatography-tandem mass spectrometry. Anal Chem. 2008 Nov 1;80(21):8115-21. doi: 10.1021/ac8009005. Epub 2008 Oct 8. — View Citation

Jacob P 3rd, Yu L, Duan M, Ramos L, Yturralde O, Benowitz NL. Determination of the nicotine metabolites cotinine and trans-3'-hydroxycotinine in biologic fluids of smokers and non-smokers using liquid chromatography-tandem mass spectrometry: biomarkers for tobacco smoke exposure and for phenotyping cytochrome P450 2A6 activity. J Chromatogr B Analyt Technol Biomed Life Sci. 2011 Feb 1;879(3-4):267-76. doi: 10.1016/j.jchromb.2010.12.012. Epub 2010 Dec 21. — View Citation

Jain RB. Levels of selected urinary metabolites of volatile organic compounds among children aged 6-11 years. Environ Res. 2015 Oct;142:461-70. doi: 10.1016/j.envres.2015.07.023. Epub 2015 Aug 7. — View Citation

Javors MA, Hatch JP, Lamb RJ. Cut-off levels for breath carbon monoxide as a marker for cigarette smoking. Addiction. 2005 Feb;100(2):159-67. — View Citation

Lee EM, Malson JL, Waters AJ, Moolchan ET, Pickworth WB. Smoking topography: reliability and validity in dependent smokers. Nicotine Tob Res. 2003 Oct;5(5):673-9. — View Citation

Matt GE, Quintana PJ, Fortmann AL, Zakarian JM, Galaviz VE, Chatfield DA, Hoh E, Hovell MF, Winston C. Thirdhand smoke and exposure in California hotels: non-smoking rooms fail to protect non-smoking hotel guests from tobacco smoke exposure. Tob Control. 2014 May;23(3):264-72. doi: 10.1136/tobaccocontrol-2012-050824. Epub 2013 May 13. — View Citation

Matt GE, Quintana PJE, Hoh E, Zakarian JM, Chowdhury Z, Hovell MF, Jacob P, Watanabe K, Theweny TS, Flores V, Nguyen A, Dhaliwal N, Hayward G. A Casino goes smoke free: a longitudinal study of secondhand and thirdhand smoke pollution and exposure. Tob Control. 2018 Nov;27(6):643-649. doi: 10.1136/tobaccocontrol-2017-054052. Epub 2018 Feb 8. — View Citation

Matt GE, Quintana PJE, Zakarian JM, Hoh E, Hovell MF, Mahabee-Gittens M, Watanabe K, Datuin K, Vue C, Chatfield DA. When smokers quit: exposure to nicotine and carcinogens persists from thirdhand smoke pollution. Tob Control. 2016 Sep;26(5):548-556. doi: 10.1136/tobaccocontrol-2016-053119. Epub 2016 Sep 21. — View Citation

Morabia A, Bernstein MS, Curtin F, Berode M. Validation of self-reported smoking status by simultaneous measurement of carbon monoxide and salivary thiocyanate. Prev Med. 2001 Jan;32(1):82-8. — View Citation

Novotny TE, Hardin SN, Hovda LR, Novotny DJ, McLean MK, Khan S. Tobacco and cigarette butt consumption in humans and animals. Tob Control. 2011 May;20 Suppl 1:i17-20. doi: 10.1136/tc.2011.043489. Review. — View Citation

Novotny TE, Slaughter E. Tobacco Product Waste: An Environmental Approach to Reduce Tobacco Consumption. Curr Environ Health Rep. 2014 May 6;1:208-216. eCollection 2014. Review. — View Citation

Oren E, Bell ML, Garcia F, Perez-Velez C, Gerald LB. Promoting adherence to treatment for latent TB infection through mobile phone text messaging: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud. 2017 Mar 13;3:15. doi: 10.1186/s40814-017-0128-9. eCollection 2017. — View Citation

Oren E, Rothers J, Stern DA, Morgan WJ, Halonen M, Wright AL. Cough during infancy and subsequent childhood asthma. Clin Exp Allergy. 2015 Sep;45(9):1439-46. doi: 10.1111/cea.12573. — View Citation

Pauly JL, Mepani AB, Lesses JD, Cummings KM, Streck RJ. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers. Tob Control. 2002 Mar;11 Suppl 1:I51-61. Review. — View Citation

Pulvers K, Emami AS, Nollen NL, Romero DR, Strong DR, Benowitz NL, Ahluwalia JS. Tobacco Consumption and Toxicant Exposure of Cigarette Smokers Using Electronic Cigarettes. Nicotine Tob Res. 2018 Jan 5;20(2):206-214. doi: 10.1093/ntr/ntw333. — View Citation

Pulvers K, Hood A, Limas EF, Thomas MD. Female smokers show lower pain tolerance in a physical distress task. Addict Behav. 2012 Oct;37(10):1167-70. doi: 10.1016/j.addbeh.2012.05.002. Epub 2012 May 22. — View Citation

Rahmanian SD, Diaz PT, Wewers ME. Tobacco use and cessation among women: research and treatment-related issues. J Womens Health (Larchmt). 2011 Mar;20(3):349-57. doi: 10.1089/jwh.2010.2173. Review. — View Citation

Ripoll J, Girauta H, Ramos M, Medina-Bombardó D, Pastor A, Alvarez-Ossorio C, Gorreto L, Esteva M, García E, Uréndez A, Buades A, Torres E. Clinical trial on the efficacy of exhaled carbon monoxide measurement in smoking cessation in primary health care. BMC Public Health. 2012 Jul 4;12:322. doi: 10.1186/1471-2458-12-322. — View Citation

Samet JM, Aladadyan L. Should the FDA Ban Cigarette Filter Ventilation? J Natl Cancer Inst. 2017 Dec 1;109(12). doi: 10.1093/jnci/djx073. — View Citation

Slaughter E, Gersberg RM, Watanabe K, Rudolph J, Stransky C, Novotny TE. Toxicity of cigarette butts, and their chemical components, to marine and freshwater fish. Tob Control. 2011 May;20 Suppl 1:i25-9. doi: 10.1136/tc.2010.040170. Erratum in: Tob Control. 2011 Nov;20(6):418. — View Citation

Song MA, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian C, O'Connor R, Rees VW, Woroszylo C, Shields PG. Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma. J Natl Cancer Inst. 2017 Dec 1;109(12). doi: 10.1093/jnci/djx075. Review. — View Citation

Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, Hartge P, Gapstur SM. 50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127. — View Citation

Tonstad S, Gustavsson G, Kruse E, Walmsley JM, Westin Å. Symptoms of nicotine toxicity in subjects achieving high cotinine levels during nicotine replacement therapy. Nicotine Tob Res. 2014 Sep;16(9):1266-71. doi: 10.1093/ntr/ntu076. Epub 2014 May 22. — View Citation

Weinberger AH, McKee SA. Mood and smoking behavior: the role of expectancy accessibility and gender. Addict Behav. 2012 Dec;37(12):1349-52. doi: 10.1016/j.addbeh.2012.07.010. Epub 2012 Jul 28. — View Citation

Wye P, Gow LB, Constable J, Bowman J, Lawn S, Wiggers J. Observation of the extent of smoking in a mental health inpatient facility with a smoke-free policy. BMC Psychiatry. 2014 Mar 29;14:94. doi: 10.1186/1471-244X-14-94. — View Citation

Zacny JP, Stitzer ML. Effects of smoke deprivation interval on puff topography. Clin Pharmacol Ther. 1985 Jul;38(1):109-15. — View Citation

Zhu SH, Pulvers K, Zhuang Y, Báezconde-Garbanati L. Most Latino smokers in California are low-frequency smokers. Addiction. 2007 Oct;102 Suppl 2:104-11. — View Citation

* Note: There are 47 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in mean flow rate (mL/s)	Mean flow rate, in mL per second, measures the flow of air through the CReSS as participants smoke cigarettes.	9 weeks
Primary	Change in number of puffs per cigarette	Measured by the CReSS device as participants smoke cigarettes	9 weeks
Primary	Change in duration of each cigarette puff (in seconds)	Measured by the CReSS device as participants smoke cigarettes	9 weeks
Primary	Change in inter-puff interval in seconds	The time between puffs on the cigarette, measured by the CReSS device as participants smoke cigarettes	9 weeks
Primary	Change in volume of each puff (mL)	Measured by the CReSS device as participants smoke cigarettes	9 weeks
Primary	Change in total smoke intake (mL)	Measured by the CReSS device as participants smoke cigarettes	9 weeks
Secondary	Urinary biomarker measurements	Target analytes are creatinine (the main proximate metabolite of nicotine), total (free + conjugated) 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (tNNAL, a carcinogenic tobacco-specific n-nitrosamine metabolite specific to tobacco smoke exposure), and a set of eight volatile organic compounds (VOCs, potentially toxic by-products of tobacco combustion). VOC concentrations will be measured at baseline in this study to account for possible additional sources of VOC exposure (assuming subjects' additional exposure remains consistent). VOCs will be measured as their urinary metabolites; i.e., mercapturic acid derivatives. The target parent VOCs are ethylene oxide, 1,3 butadiene, crotonaldehyde, acrolein, benzene, acrylamide, acrylonitrile, and propylene oxide. The biomarkers' urine concentration will be normalized to creatinine. Baseline midstream urine samples of at least 30 mL will be collected at baseline, post-washout, and at the end of each study cigarette period.	9 weeks
Secondary	Cigarette satisfaction: mCEQ	Satisfaction with test cigarettes will be assessed using the 12-item modified Cigarette Evaluation Scale (mCEQ). This validated tool uses visual analog scales to assess subjective ratings: general acceptability ("bad" to "very good"), smoking need ("not at all" to "very strong"), smoking satisfaction ("not at all" to "very good"), harshness ("not at all" to "very strong") and pleasantness of smoke taste ("not tasty at all" to "very tasty"). Open-ended questions will also be asked regarding subject's experience smoking unfiltered cigarettes.	9 weeks
Secondary	Change in answers to Stanford Perceptions Survey of Youth questions	Qualitative questions assessing knowledge abut cigarette filters, behaviors if filtered cigarettes were no longer available, and support for policy related to filtered cigarettes.	9 weeks
Secondary	Change in perceptions of cigarette harshness	As measured by a visual analog scale of 0 (not harsh at all) to 100 (extremely harsh)	9 weeks
Secondary	Change in perceptions of cigarette draw	As measured by a visual analog scale of 0 (very hard to draw smoke) to 100 (very easy to draw smoke)	9 weeks