Effects of very low nicotine content cigarettes and concurrent provision of e-cigarettes on symptoms of depression and anxiety.

A national nicotine-reduction policy could reduce cigarette smoking in the United States. The present study evaluated effects of cigarettes varying in nicotine content and provision of e-cigarettes on affective symptoms in populations with vulnerabilities to smoking. The overarching aim was to examine whether a nicotine-reduction policy could have unintended negative consequences, including exacerbation of psychiatric symptoms. This is a secondary analysis of three parallel 16-week randomized clinical trials examining four experimental conditions: normal nicotine content cigarettes, very-low-nicotine-content (VLNC) cigarettes, VLNC cigarettes plus e-cigarettes restricted to tobacco flavor (VLNC + TF), or VLNC cigarettes plus e-cigarettes in preferred flavors (VLNC + PF). Participants were adults who smoked daily from three vulnerable populations: socioeconomically disadvantaged reproductive-aged women (n = 80) and individuals with opioid use disorder (n = 74) or affective disorders (n = 172). Beck Depression Inventory and Overall Anxiety Severity and Impairment Scale scores were assessed weekly. There was a significant effect of experimental condition on Beck Depression Inventory, F(3, 315) = 4.26, p = .006, and Overall Anxiety Severity and Impairment Scale, F(3, 315) = 4.26, p = .006, scores, with scores in the VLNC only (least square means and standard error of the means: 12.68 [± 0.53] and 5.58 [± 0.27]), but not VLNC + TF or VLNC + PF conditions exceeding those in the normal nicotine content condition (least square means standard error of the means: 10.66 [± 0.53], p = .006 and 4.69 [± 0.27], p = .004). There was also a significant main effect of time, Beck Depression Inventory: F(15, 4050) = 3.74, p < .001; Overall Anxiety Severity and Impairment Scale: F(15, 4050) = 2.24, p = .004, with scores decreasing over the experimental period across experimental conditions. In conclusion, providing VLNC cigarettes in combination with e-cigarettes appeared to ameliorate modest increases in affective symptoms observed when VLNC cigarettes were provided alone. (PsycInfo Database Record (c) 2025 APA, all rights reserved).