Changes in weight among individuals with psychiatric conditions or socioeconomic disadvantage assigned to smoke very low nicotine content cigarettes.

Nicotine abstinence leads to weight gain, which could be an unintended consequence of a nicotine reduction policy. This secondary analysis used weekly assessments of weight and ratings of "increased appetite/hunger/weight gain" collected in three 12-week, randomized controlled trials evaluating the effects of cigarettes differing in nicotine dose (15.8, 2.4, or 0.4 mg/g) among individuals with affective disorders, opioid use disorder (OUD), and socioeconomically disadvantaged women. Linear mixed models tested differences by dose and time. Analyses first collapsed across populations and then separated out individuals with OUD because biomarkers suggested they used substantially more noncombusted nicotine. Across populations, weight increased significantly over time, averaging 1.03 kg (p < .001), but did not vary by dose nor was there any interaction of dose/time. "Increased appetite/hunger/weight gain" ratings increased significantly as a function of dose, with differences between low and high doses (1.95 and 1.73, respectively, p = .01), but not by time nor any interaction. In the combined group of individuals with affective disorders and socioeconomically disadvantaged women, weight and "increased appetite/hunger/weight gain" ratings increased significantly by dose, with differences between low and high doses (1.43 vs. 0.73 kg, p = .003 and 2.00 vs. 1.76, p = .02, respectively). Among individuals with OUD, there were no significant effects of any kind on either outcome. Individuals with affective disorders and socioeconomically disadvantaged women gained weight and reported more subjective appetite/weight gain when given 0.4, but not 2.4 mg/g cigarettes, despite comparable decreases in nicotine exposure. However, neither change was clinically significant, suggesting minimal short-term adverse consequences of a nicotine reduction policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reasons for past abortions among women in treatment for opioid use disorder.

OBJECTIVE: The main reasons women in the general population seek abortion are financial, timing, and partner-related reasons. While women with opioid use disorder (OUD) appear to use abortion services more than women in the general population, reasons for abortion in this group have not been examined to our knowledge. METHOD: Female patients aged 18-50 years in OUD treatment at 22 randomly selected facilities in Michigan were surveyed. The survey included items assessing reproductive health history. Women who reported having one or more abortions were asked to think back to that time and their reasons for choosing abortion. Twenty potential reasons and a write-in option were offered; women could endorse as many as applied. RESULTS: Of 260 women surveyed, 84 reported having an abortion. Of these, most (77.4%) reported multiple reasons for having an abortion. The most common reasons for having an abortion were not having money to take care of a baby (54.8%), feeling too young to have a child and not feeling ready to be a mother (both 42.9%), not loving the father and other partner-related concerns (25.0%-32.1%), and having concerns about the effects of their drug use (28.6%). No combination of reasons for abortion emerged as more prevalent than any other. CONCLUSIONS: Like women in the general population, women in treatment for OUD had not only abortions because of financial, timing, and partner-related reasons but also concerns about the effects of their drug use. These results underscore the multiple and often interrelated reasons that lead women to seek abortion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relating individual differences in the reinforcing value of smoking and dependence severity to nicotine exposure levels in vulnerable populations.

Cigarette smoking is overrepresented in populations with psychiatric conditions and socioeconomic disadvantage. Greater understanding of the role of reinforcement and nicotine dependence in smoking among vulnerable populations may facilitate development of better targeted interventions to reduce smoking. Prior research demonstrated that individual differences in the reinforcing value of smoking and nicotine-dependence severity predicted total nicotine-exposure in vulnerable populations. The present study uses multivariate regression to address two aims: (1) Quantify the degree to which the reinforcing value of smoking, assessed using the Cigarette Purchase Task (CPT), and dependence severity assessed using the Fagerström Test of Nicotine Dependence and Brief Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) each account for individual differences in cotinine-plus-3'-hydroxycotinine (COT+3HC) levels. (2) Explore whether there is overlap in the variance accounted for by the CTP, FTND, and B-WISDM. Participants were 628 adults with co-morbid psychiatric conditions or socioeconomic disadvantage who smoked daily. The CPT, FTND, and B-WISDM models accounted for 23.76%, 32.45%, and 29.61% of the variance in COT+3HC levels, respectively. Adding CPT to the FTND model failed to increase the variance accounted for and adding it to the B-WISDM model did so by only 1.2% demonstrating considerable overlap in the variance in nicotine exposure levels accounted for by these three instruments. These results provide new knowledge on the relationship between individual differences in the reinforcing value of smoking and nicotine-exposure levels and suggest differences in reinforcing value may underpin a considerable portion of the variance in nicotine exposure accounted for by dependence severity.

Stigma and Reproductive Health Service Access Among Women in Treatment for Substance Use Disorder.

OBJECTIVE: We aimed to examine the role of perceived and direct stigma on access to reproductive health services among women in treatment for substance use disorders in Michigan. METHODS: We draw on self-interview data from a cross-sectional study of female patients aged 18-50 years who accessed substance use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. We conducted logistic regressions to examine associations between perceived stigma and access to three types of reproductive health services (screening exams, birth control, and prenatal care), as well as direct stigma and access to birth control. RESULTS: The final sample included 260 women. A notable percentage of women reported inability to access reproductive health services (24% for screening exams, 14% for birth control, and 12% for prenatal care). Women with higher levels of perceived stigma because of substance use were significantly more likely to report inability to access screening exams (odds ratio [OR]: 2.14; confidence interval [CI]: 1.43-3.20) and birth control (OR: 2.17; CI: 1.36-3.77). Women reporting higher levels of direct stigma were also significantly more likely to report inability to access birth control (OR: 3.87; CI: 2.29-6.53), even after accounting for perceived stigma. CONCLUSION: Perceived and direct stigma because of substance use may be significant barriers to seeking and accessing reproductive health services for women. Health professionals should reduce stigma in health care in order to increase access to necessary services for this population.

Cumulative vulnerabilities as a potential moderator of response to reduced nicotine content cigarettes.

Risk for smoking increases in a summative manner corresponding to the number of co-occurring vulnerabilities present (cumulative vulnerability). We examined whether cumulative vulnerabilities moderate response to reduced nicotine content cigarettes in a secondary analysis of results from 775 participants in three 12-week randomized clinical trials examining research cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco). Participants were categorized as having 0-1, 2-3, or ≥ 4 cumulative vulnerabilities. Vulnerabilities included: rural residence, current substance use disorder, current affective disorder, low educational attainment, poverty, unemployment, physical disability. The primary outcome was total cigarettes per day (CPD) during Week 12; secondary outcomes included CPD across weeks, toxin exposure, dependence severity, craving/withdrawal (17 dependent measures). Results were analyzed using repeated measures analysis of covariance and growth-curve modeling. Total CPD during Week 12 increased as cumulative-vulnerability increased (P = 0.004), and decreased as nicotine content decreased (P < 0.001), with no significant interaction of cumulative vulnerability and dose (P = 0.67). Effects on other outcomes generally followed that same pattern. The only exception across the other outcomes was on Questionnaire-on-Smoking-Urges Factor-2 ratings for usual-brand cigarettes where cumulative vulnerability, dose, and time interacted (P = 0.007), with craving at the 0.4 and 2.4 mg/g doses decreasing over time, but inconsistently across vulnerability categories. Overall, we saw little evidence that cumulative vulnerabilities moderate response to reduced nicotine content cigarettes suggesting that a policy reducing nicotine content in cigarettes to minimally addictive levels could benefit even highly vulnerable smokers including those residing in rural or other regions with overrepresentation of co-occurring vulnerabilities. Clinicaltrials.gov identifiers: NCT02232737, NCT02250664, NCT02250534.

Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials.

Importance: This study is part of a programmatic effort evaluating the effects of reducing nicotine content of cigarettes to minimally addictive levels. Objective: To examine whether very low-nicotine-content (VLNC) cigarettes decrease smoking rates and dependence severity among smokers with psychiatric disorders or socioeconomic disadvantage. Design, Setting, and Participants: These 3 randomized clinical trials were performed at the University of Vermont, Brown University, and Johns Hopkins University between October 2016 and September 2019. Participants received 12 weeks of exposure to study cigarettes with nicotine content ranging from levels representative of commercial cigarettes (15.8 mg nicotine/g tobacco) to less than a hypothesized addiction threshold (2.4 mg/g and 0.4 mg/g). Daily smokers from 3 at-risk populations participated: individuals with affective disorders, exemplifying smokers with mental illness; individuals with opioid use disorder, exemplifying smokers with substance use disorders; and women with high school educations or less, exemplifying smokers with socioeconomic disadvantage. Data were analyzed from September 2019 to July 2020. Interventions: Random assignment to 1 of 3 study cigarettes provided weekly at no cost for 12 weeks. Main Outcomes and Measures: The primary outcome was between-group differences in mean total cigarettes smoked daily (CPD) during week 12; secondary outcomes included CPD for study and nonstudy cigarettes and dependence severity across weeks analyzed using analysis of covariance, random coefficients growth modeling, or repeated measures analysis of variance. Results: A total of 775 participants were included (mean [SD] age, 35.59 [11.05] years; 551 [71.10%] women [owing to 1 population being exclusively women]); participants smoked a mean (SD) of 17.79 (9.18) CPD at study intake. A total of 286 participants were randomized to 0.4 mg/g, 235 participants were randomized to 2.4 mg/g, and 254 participants were randomized to 15.8 mg/g. Participants randomized to VLNC cigarettes had decreased mean [SEM] total CPD during week 12 across populations (Cohen d = 0.61; P < .001). At week 12, mean (SEM) CPD decreased to 17.96 (0.98) CPD in the 0.4 mg/g group and to 19.53 (1.07) CPD in the 2.4 mg/g group, both of which were significantly different from the 15.8 mg/g group (25.08 [1.08] CPD at week 12) but not each other (0.4 mg/g adjusted mean difference: -7.54 [95%CI, -9.51 to -5.57]; 2.4 mg/g adjusted mean difference: -5.34 [95% CI, 7.41 to -3.26]). Several secondary outcomes differed across populations randomized to VLNCs, including mean total CPD across weeks, with linear trends lower in participants receiving 0.4 mg/g (-0.28 [95%CI, -0.39 to -0.18]; P < .001) and 2.4 mg/g (-0.13 [95%CI, -0.25 to -0.01]; P < .001) doses compared with those receiving the 15.8 mg/g dose (0.30 [95% CI, 0.19 to 0.41]). Fagerström Test of Nicotine Dependence mean total scores were significantly lower in participants who received VLNCs (Cohen d = 0.12; P < .001), with those who received the 0.4 mg/g dose (mean [SD] score, 3.99 [0.06]; P < .001 vs 15.8 mg/g) or 2.4 mg/g dose (mean [SD] score, 4.07 [0.06]; P = .01 vs 15.8 mg/g) differing from those who received the 15.8 mg/g dose (mean [SD] score, 4.31 [0.06]) but not from each other. Conclusions and Relevance: These findings demonstrate that decreasing the nicotine content of cigarettes to very low levels reduced smoking rate and nicotine-dependence severity in these high-risk populations, effects that may facilitate successful cessation. Trial Registration: ClinicalTrials.gov Identifiers: NCT02232737, NCT02250664, NCT02250534.

Abuse liability of cigarettes with very low nicotine content in pregnant cigarette smokers.

The U.S. Food and Drug Administration has proposed reducing the nicotine content of cigarettes to a minimally-addictive level. To our knowledge, this study is the first to examine how pregnant smokers respond to very low nicotine content (VLNC) cigarettes. In Phase 1, participants blindly sampled two VLNC cigarettes (0.4 and 2.4 mg/g of tobacco) and their usual brand (UB) cigarette in separate sessions, then completed a behavioral economic simulation task and measures of subjective effects, craving/withdrawal, and smoking topography. Phase 2 directly compared the relative reinforcing effects of the cigarettes using concurrent choice testing. All possible dose-pair combinations were tested in separate sessions where puffs were earned ad libitum by clicking the code associated with their preferred cigarette 10 times. Phase 3 tested the 0.4 mg/g-UB dose-pair where UB puffs could be earned with a progressively incremented number of clicks (maximum 8400). Ten pregnant smokers in Burlington, VT and Baltimore, MD participated in 2017-2018. Regarding abuse liability, participants chose the 0.4-mg/g dose less than UB (22% vs. 78%) during concurrent choice testing and the 0.4-mg/g dose sustained less demand than the 2.4-mg/g and UB doses on the simulation task. Positive subjective effects were also lower for both VLNC cigarettes vs. UB. Each cigarette reduced nicotine craving/withdrawal and no significant changes indicative of compensatory smoking were noted. Reducing the nicotine content of cigarettes may decrease their abuse liability in pregnant smokers without causing untoward craving/withdrawal or compensatory smoking. Studies of extended exposure to VLNCs in pregnant women are warranted.

Sexual and Reproductive Health Characteristics of Women in Substance Use Treatment in Michigan.

OBJECTIVE: To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired. METHODS: We conducted a cross-sectional study of female patients aged 18-50 years who accessed opioid use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. Computer-assisted self-interviews were completed using online survey management software to assess prior substance use and use disorder treatment, sexual and reproductive health history, and sexual and reproductive health services received in the previous 12 months through a treatment program, and desire for and barriers to sexual and reproductive health services within substance use disorder treatment. Descriptive statistics were calculated. RESULTS: The final sample consisted of 260 participants. About half (51.5%) had ever had an abnormal Pap test result, and 57.3% had ever tested positive for a sexually transmitted infection. Unintended pregnancy was common (61.2%), as was substance use during pregnancy (74.2%). Nearly half (46.5%) were not currently using a method of contraception, and only 28.5% were using a highly effective method. Common barriers to accessing reproductive health services included fear of being treated poorly or judged because of substance use, fear of child protective services, and structural barriers such as cost and lack of transportation. Most participants (80.4%) indicated interest in receiving sexual and reproductive health services on site or by referral from their substance use disorder treatment programs. CONCLUSION: Women in treatment for opioid use disorder in Michigan have high rates of adverse sexual and reproductive health experiences and face barriers to accessing care.

Substance Use Treatment Patient and Provider Perspectives on Accessing Sexual and Reproductive Health Services: Barriers, Facilitators, and the Need for Integration of Care.

Background: Women with substance use disorders have high rates of adverse sexual and reproductive health (SRH) outcomes, including unintended pregnancy, sexually transmitted infections, and contraceptive nonuse. Little research has explored barriers and facilitators to accessing SRH services experienced by women with substance use disorders. Objectives: To investigate barriers and facilitators to accessing SRH services experienced by women with substance use disorders. To assess perspectives on integration of SRH services into substance use treatment. Methods: Twenty-nine semi-structured interviews were conducted with female patients (N = 17) and providers (N = 12) at four substance use treatment facilities in Michigan between October 2015 and January 2016. Respondents were asked about experiences accessing SRH services and perspectives on integration of SRH services into substance use treatment. Data were analyzed using the constant comparative method. Results: Patients and providers discussed barriers to accessing SRH services, including competing priorities, structural barriers, lack of knowledge on SRH services and substance use, fear of Child Protective Services and law enforcement, and stigma. Facilitators included reprioritization of SRH, accessible transportation, insurance coverage and funding for SRH services, and education and training on SRH. Finally, participants expressed support for integration of SRH services into substance use treatment. Conclusions/Importance: Understanding the barriers to accessing SRH services is essential to reducing the adverse SRH outcomes experienced by women with substance use disorders. Substance use treatment is a critical time to offer SRH services. Integration of care is a potential model for improving the SRH of women with substance use disorders.