Importance  A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States.

Objective  To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content.

Design, Setting, and Participants  A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016.

Interventions  After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions.

Main Outcomes and Measures  Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale.

Results  Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η² = 0.008; dose-by-time interaction, P = .002).

Conclusions and Relevance  Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.

重要性  正在考虑一项国家政策，以减少卷烟的尼古丁含量，以降低美国的尼古丁成瘾潜力。

目的  研究患有精神病和其他易上瘾的吸烟者对烟碱含量降低的香烟的反应。

设计，环境和参与者  多点，双盲，参与者内部评估对尼古丁含量从低于假定成瘾阈值的水平到代表商业卷烟（0.4、2.3、5.2和15.8 mg）的研究卷烟的急性反应3个学术场所的每日吸烟者包括来自以下3个脆弱人群的169名吸烟者：情感障碍患者（n = 56）或阿片类药物依赖患者（n = 60）和社会经济弱势妇女（n = 53）。数据收集时间为2015年3月23日至2016年4月25日。

干预措施  短暂戒烟后，参加者在14到2到4个小时的门诊疗程中接受了不同烟碱剂量的香烟接触。

主要结果和措施  使用同时选择测试，“卷烟购买任务”（CPT）和经过验证的主观措施（例如明尼苏达州尼古丁戒断量表）评估卷烟的潜在成瘾性。

结果  分析的169名每日吸烟者（120名女性[71.0％]和49名男性[29.0％]；平均[SD]年龄为35.6 [11.4]岁），降低香烟中尼古丁含量降低了吸烟的相对增强作用在所有3个人群中吸烟。在整个人群中，选择的0.4 mg / g剂量显着小于同期选择试验中的15.8 mg / g剂量（平均值[SEM] 30％[0.04％] vs 70％[0.04％]； Cohen d  = 0.40；P  <.001）并降低了CPT的需求（α= .027 [95％CI，0.023-0.031] vsα= .019 [95％CI，0.016-0.022]; Cohen d  = 1.17; P <.001）。可以通过增加获得更高剂量所需的响应成本来扭转对高烟碱含量香烟的偏爱（平均[SEM]分别为61％[0.02％]和39％[0.02％]； Cohen d  = 0.40；P  <。 001）。所有剂量减少明尼苏达尼古丁戒断量表的总分数（平均值范围减小，0.10-0.50;科恩d范围内，0.21-1.05; P  <0.001对所有），尽管戒断症状持续时间在较高剂量是大于（η ²  = 0.008 ；按时间剂量的相互作用，P  = .002）。

结论和相关性  降低卷烟中尼古丁含量可能会降低极易吸烟成瘾人群的成瘾潜力。患有精神疾病和社会经济劣势的吸烟者更容易上瘾，戒烟的可能性较小，对健康的不利影响更大。需要减少这些差距的政策；减少卷烟中尼古丁含量应成为政策重点。