An Evaluation of Potential Unintended Consequences of a Nicotine Product Standard: A Focus on Drinking History and Outcomes.

Background A nicotine product standard reducing the nicotine content in cigarettes could improve public health by reducing smoking. This study evaluated the potential unintended consequences of a reduced-nicotine product standard by examining its effects on (1) smoking behaviors based on drinking history; (2) drinking behavior; and (3) daily associations between smoking and drinking. Methods Adults who smoke daily (n=752) in the United States were randomly assigned to smoke very low nicotine content (VLNC) versus normal nicotine content (NNC; control) cigarettes for 20 weeks. Linear mixed models determined if baseline drinking moderated the effects of VLNC versus NNC cigarettes on Week 20 smoking outcomes. Time-varying effect models estimated the daily association between smoking VLNC cigarettes and drinking outcomes. Results Higher baseline alcohol use (versus no-use or lower use) was associated with a smaller effect of VLNC on Week 20 urinary total nicotine equivalents (ps .05). In the subsample who drank (n=415), in the VLNC versus NNC condition, daily alcohol use was significantly reduced from Week 17-20 and odds of binge drinking were significantly reduced from Week 9-17. By Week 7 in the VLNC cigarette condition (n=272), smoking no longer predicted alcohol use but remained associated with binge drinking. Conclusions We did not support negative unintended consequences of a nicotine product standard. Nicotine reduction in cigarettes generally impacted smoking behavior for individuals who do not drink or drink light-to-moderate amounts in similar ways. Extended VLNC cigarette use may improve public health by reducing drinking behavior. Implications There was no evidence that a very low nicotine content product standard would result in unintended consequences based on drinking history or when considering alcohol outcomes. Specifically, we found that a very low nicotine standard in cigarettes generally reduces smoking outcomes for those who do not drink and those who drink light-to-moderate amounts. Furthermore, an added public health benefit of a very low nicotine standard for cigarettes could be a reduction in alcohol use and binge drinking over time. Finally, smoking very low nicotine content cigarettes may result in a decoupling of the daily associations between smoking and drinking.