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卫生问题。约 11%的美国女性（约1700万女性）在怀孕时吸烟， 在社会经济处境不利的妇女中，这一比例为40%。怀孕期间吸烟会导致灾难性的 越来越多的证据表明， 会影响整个生命周期的健康降低香烟尼古丁含量的国家政策 有可能成为一种有效的方法，减少吸烟的流行和吸烟- 在这一高度脆弱的人群中产生的相关不良健康后果。一般人群中的对照试验 例如，吸烟者的研究表明，尼古丁含量降低的香烟 吸烟率、依赖性和毒素暴露水平。此外，我们的研究在目前的资金 报告指出，在社会经济上处于不利地位的未怀孕妇女和其他易受 持续使用烟草（患有阿片类药物使用障碍或情感障碍的吸烟者），也对减少 香烟尼古丁含量与香烟需求量的减少和成瘾可能性的其他措施。 重要的是，没有证据表明尼古丁戒断或代偿性吸烟与吸烟有关。 在这些人群中使用尼古丁含量降低的香烟，这在考虑使用时很重要 在孕妇中。我们不知道在文献中的经验资料的影响减少 尼古丁含量的香烟在孕妇，虽然他们预计将获得同样的好处， 非孕妇吸烟率降低，依赖程度降低，沿着 减少尼古丁暴露对胎儿的额外潜在益处。由于这些原因，我们目前 进行一项多地点研究，探讨尼古丁含量降低的香烟对成瘾的急性影响。 使用类似于我们对非妊娠妇女使用的方案， 妇女拟议的多中心试验将通过检查扩展的 exposure.怀孕的吸烟者将被随机抽普通牌子的香烟或低尼古丁香烟 含量香烟（0.4 mg尼古丁/g烟草）12周。香烟和其他烟草的使用模式， 香烟需求，依赖，毒物暴露的生物标志物，胎儿的超声评估 将检查生长和身体组成。总的来说，拟议的研究与CTP的兴趣一致 在支持弱势群体和科学领域的综合主题下的研究， 成瘾和行为，以及健康影响。本研究具有重要的创新意义， 模拟降低香烟中尼古丁标准的国家政策如何影响高度脆弱的 吸烟人口，并通过逐步建立一个全面的评估方案， 急性和长期暴露于尼古丁含量降低的香烟对孕妇的影响。

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.