Discussion
MTSS, throat
In this cross-over randomized study of UK adult cigarette smokers naïve to NVPs and HTPs, we directly compared NVP and HTP short-term use in terms of cigarette-related withdrawal relief, acute positive effects and adverse side-effects, intention to switch and reasons for motivating smokers switching, as well as attitudes towards them and perceptions about them compared to cigarettes, and we observed little differences. Both products reduced cigarette cravings and withdrawal symptoms effectively and to a similar degree. Acute positive effects and adverse side-effects were comparable, if marginally favouring HTPs. Relative to cigarettes HTPs were perceived as more satisfying than NVPs but both products were seen as addictive as each other compared with cigarettes. Lastly, intention to switch to either product did not differ.Consistent with previous findings demonstrating reliable nicotine delivery after acute administration using NVP and HTP (e.g.,Levels of acute positive effects were close to the middle values of the scales, and slightly higher after HTP use compared to after NVP use. Participants felt that the HTP had reduced their craving for nicotine, it was satisfying, and it felt like their usual cigarette brand. Unlike NVPs, HTPs contain tobacco leaf, and their flavour may more closely resemble cigarette smokeThe minimal adverse side-effects, the middling acute positive effects and the favourable attitudes reported after NVP and HTP use may indicate these products are viable cigarette substitutes that could promote switching. However, when participants were asked directly their intention to switch to these products, 46.7% and 42.2% replied that this was somewhat unlikely for NVP and HTP, respectively. One reason for this is that even the HTP, which was considered more satisfying than the NVP, was still perceived as less satisfying compared with cigarettes. It could also be attributed to the fact that motivation to quit smoking assessed before product use was moderate, and this acute experience of NVP/HTP use was not enough to change participants’ intention to substitute smoking with another nicotine delivery device. Additionally, our sample included adult cigarette smokers naïve to NVPs and HTPs, which may further suggest that these people purposively stayed away from trying to use these products and thus might be harder to persuade to switch. Interestingly, a few participants who reported no intention to quit smoking in the next 3 months (based on the MTSS scale), reported that they were somewhat likely/very likely switching to NVPs and HTPs (22.2% and 20.0% respectively), which may indicate that these products could substitute cigarette smoking in smokers unmotivated to quit and contribute to harm reduction. Similar to previous research among cigarette smokers, we found that the most important reasons for switching to NVPs/HTPs were satisfaction, to reduce harm to themselves and others, to reduce smoking, and to help them stop smokingFinally, views on the safety of these novel products were somewhat out of step with the evidence. NVPs generally expose users to much lower levels of carcinogens and toxicants than cigarettesAll results obtained should be seen in the light of the following limitations. First, the results and their interpretations are based on a small convenience sample of London-based adults. Though considering the cross-over design of the study, the sample is equivalent to having at least double the sample of a parallel-group randomised trial. Nonetheless, the sample is unlikely to be representative for the average regular smoker. Yet, many of our findings are comparable to other studies (i.e.To conclude, comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes. Few differences were observed between the two products for other outcomes. Both products reduced cigarettes cravings and were seen as similarly addictive to each other when compared to cigarettes. The perceived adverse side-effects after using each product were minimal, apart from throat irritation after Aspire PockeX NVP use. Acute positive effects were modest and attitudes towards both products were favourable, though intention to switch to either product was relatively low. Nonetheless, given the comparable psychopharmacological profile and perceived acceptability of both products, taken together with the now established effectiveness of NVP for smoking cessation, this would suggest that HTP may play a useful role in combustible tobacco harm reduction.