Short-term abstinence effects in experienced electronic cigarette users

Short-term abstinence effects in experienced electronic cigarette users Nicholas J. Felicione Nicotine/tobacco dependence is a problem that negatively affects health at an individual and population level. Nicotine/tobacco dependence may be best assessed by measuring withdrawal symptoms of a nicotine/tobacco user who abstains from use. Withdrawal symptoms experienced by cigarette smokers are well characterized, including deficits in attention and memory, as well as self-reported cravings, urges, and other symptoms. While withdrawal in cigarette smokers has been studied extensively, little is known about dependence and withdrawal associated with newer products, such as electronic cigarettes (ECIGs). ECIGs can deliver nicotine comparably to tobacco cigarettes, indicating that they may have the potential to cause dependence. However, extant work assessing ECIG dependence and withdrawal is confounded by current or previous cigarette smoking in ECIG users. Thus, the purpose of this project was to characterize cognitive, subjective, and physiological measures of ECIG withdrawal in ECIG users who are not regular cigarette smokers. Eleven ECIG users that were primarily nonsmokers participated in two, 3.5hour sessions that differed by ECIG use: 180 minutes ad lib ECIG use and 180 minutes abstinent. Outcome measures included subjective questionnaires of withdrawal and nicotine effects, heart rate, cognitive assessments of sustained attention, working memory, and inhibitory control, and ECIG reward. Participants subjectively reported more craving, urges, and desire to vape at 120 to 180 minutes of abstinence compared to baseline. Participants also had poorer accuracy on an inhibitory control task at 120 minutes of abstinence compared to baseline abstinence or 120 minutes of ad lib ECIG use. Additional analyses included assessing characteristics that predict ECIG dependence, characterizing ad lib puff topography, and predicting withdrawal based on puff topography. Higher nicotine concentrations, daily ECIG use, longer durations of ECIG use, and higher wattages were associated with increased nicotine dependence. Results of this study demonstrate preliminary evidence of short-term withdrawal in ECIG users that are primarily nonsmokers, though findings are limited by a small sample size. Future research should be continue with similar experimental designs but increase sample size and assess longer durations of abstinence to better characterize ECIG withdrawal and dependence. ACUTE ABSTINENCE EFFECTS OF ECIG USERS iii Acknowledgements The completion of this dissertation project would not have been successful without the contribution and support of multiple people. I would like to thank my advisor, Dr. Melissa Blank, for her training, guidance, and unconditional support throughout this project and my graduate career. I appreciate the useful suggestions and feedback to improve the project from my committee members, Dr. Kevin Larkin, Dr. James Mahoney III, Dr. F. Joseph McClernon, and Dr. Cole Vonder Haar. Additional thanks go to Drs. McClernon and Mahoney for their expertise and assistance regarding cognitive assessments and programming of tasks. Finally, I would like to thank my lab mates who provided help on this project, Ilana Haliwa and Dani Kisner. Dani contributed many hours of work into video scoring for this project, and I appreciate her commitment to this task. This work was supported by the West Virginia University Eberly College of Arts and Sciences / Department of Psychology Doctoral Research Award. ACUTE ABSTINENCE EFFECTS OF ECIG USERS iv Table of