Low Nicotine Content Cigarettes in Vulnerable Populations: Pregnant Women

怀孕期间吸烟仍然是一个严重的公共健康问题。大致 11%的美国女性(约1700万女性)怀孕时是烟民，吸烟率很高 在社会经济上处于不利地位的女性中的比例为40%。怀孕期间吸烟会造成灾难性的后果 越来越多的证据表明，妊娠并发症和对胎儿发育的不良影响 可能会危及整个生命周期的健康。降低香烟中尼古丁含量的国家政策 有潜力成为降低吸烟和吸烟流行率的有效方法- 在这一高度脆弱的人群中出现相关的不良健康后果。普通人群中的对照试验 例如，吸烟者的研究表明，尼古丁含量减少的香烟会减少香烟的数量 吸烟率、依赖度和毒素暴露水平。此外，我们的研究在目前的资金支持下 时期表明，社会经济上处于不利地位的非怀孕妇女，以及其他易受感染的群体 持续吸烟(有阿片类药物使用障碍或情感障碍的吸烟者)，也会对减少的 香烟的尼古丁含量与香烟需求的减少和其他成瘾潜力的衡量标准。 重要的是，没有证据表明令人不快的尼古丁戒断或补偿性吸烟与 在这些人群中使用减少尼古丁含量的香烟，这在考虑其使用时是重要的 在怀孕的妇女中。我们知道在文献中没有关于减少的影响的经验性信息 孕妇中含有尼古丁的香烟，尽管它们有望获得与 非怀孕妇女吸烟率降低和依赖严重程度降低，以及 减少尼古丁暴露对胎儿的其他潜在好处。出于这些原因，我们目前 进行一项多点研究，考察减少尼古丁含量的香烟对成瘾的急性影响 孕妇吸烟的可能性，使用与我们对非孕妇使用的相似的方案 女人。拟议的多点试验将通过检查扩展的 曝光。怀孕的吸烟者将被随机分成两组，要么吸普通牌子的香烟，要么吸非常低的尼古丁 香烟含量(0.4毫克尼古丁/克烟草)，持续12周。香烟和其他烟草使用的模式， 香烟需求、依赖、毒物暴露的生物标记物以及胎儿的超声评估 将对生长和身体成分进行检查。总体而言，拟议的研究与CTP的兴趣很好地一致 支持在弱势群体和科学领域的综合主题下的研究 上瘾和行为，以及对健康的影响。这项研究具有重要的创新意义，尝试 模拟降低香烟中尼古丁标准的国家政策可能如何影响高度脆弱的 吸烟者人数，并通过循序渐进地建立对 孕妇对尼古丁含量降低的香烟的急性和长期暴露的影响。

Cigarette smoking during pregnancy continues to represent a serious public health problem. Approximately 11% of U.S. women (~17 million women) are smokers when they become pregnant, with prevalence as high as 40% among socioeconomically disadvantaged women. Smoking during pregnancy can cause catastrophic pregnancy complications and adverse effects on fetal development that a growing body of evidence suggests can compromise health throughout the lifespan. A national policy of reducing the nicotine content of cigarettes has the potential to be an effective method of reducing the prevalence of cigarette smoking and smoking- related adverse health outcomes in this highly vulnerable population. Controlled trials in the general population of smokers, for example, have demonstrated that reduced nicotine content cigarettes decrease cigarette smoking rates, dependence, and toxin exposure levels. Furthermore, our research during the current funding period indicates that socioeconomically disadvantaged non-pregnant women, and other groups vulnerable to persistent tobacco use (smokers with opioid use disorders or affective disorders), also respond to reduced nicotine content of cigarettes with reductions in cigarette demand and other measures of addiction potential. Importantly, there is no evidence of untoward nicotine withdrawal or compensatory smoking associated with use of reduced nicotine content cigarettes in these populations, which is important when considering their use among pregnant women. We know of no empirical information in the literature on the effects of reduced nicotine content cigarettes in pregnant women, although they would be expected to reap the same benefits as non-pregnant women with regard to reduced smoking rates and lower dependence severity, along with additional potential benefits to the fetus from reduced nicotine exposure. For those reasons, we are currently conducting a multi-site study examining acute effects of reduced nicotine content cigarettes on the addiction potential of smoking in pregnant women using a protocol similar to the one we used with the non-pregnant women. The proposed multi-site trial will further this important line of research by examining extended exposure. Pregnant smokers will be randomized to smoke either usual brand cigarettes or very low nicotine content cigarettes (0.4 mg nicotine/g tobacco) for 12 weeks. Patterns of cigarette and other tobacco use, cigarette demand, dependence, biomarkers of toxicant exposure, and sonographic assessments of fetal growth and body composition will be examined. Overall, the proposed research aligns well with CTP's interest in supporting research under the integrative theme of Vulnerable Populations and the scientific domains of Addiction and Behavior, as well as Health Effects. The research is significant an innovative by attempting to model how a national policy of reduced nicotine standards in cigarettes may impact a highly vulnerable population of smokers, and programmatic by building incrementally towards a comprehensive assessment of the effects of acute and extended exposure to reduced nicotine content cigarettes in pregnant women.