Assessing the Impacts of Sensorimotor Stimuli and Nicotine Content on Cravings and Other Outcomes of E-Cigarette Use

As use rates of e-cigarettes continue to rise, especially among cigarette smokers, there remains concern that “dual use” may lead to increased dependence and hinder smoking cessation efforts. At the same time, emerging evidence suggests clinical efficacy of e-cigarettes. The role of nicotine must be considered, in addition to non-pharmacologic influences, such as expectancies or conditioned reinforcers. Sensorimotor stimuli associated with drug delivery have been demonstrated to produce cigarette and e-cigarette craving reduction, even without the nicotine. The purpose of the present study was to parse the influences of nicotine and sensorimotor delivery on various outcomes of e-cigarette use, including craving reduction. In this design, drug dosage (open label nicotine vs non-nicotine e-cigarettes) was crossed with sensorimotor manipulation (sensorimotor deprivation vs natural). Participants (N=127 dual users) completed an experimental visit that included an ad-lib vaping session with either a standard e-cigarette or a modified stationary apparatus (sensorimotor deprivation). It was hypothesized that the sensorimotor manipulation would primarily affect subjective, psychosocial outcomes, and nicotine would primarily influence objective, physiological outcomes. However, results showed main effects of both nicotine (ps\u3c.01) and delivery (ps\u3c.05) on both cravings to smoke and cravings to vape, with greater craving reduction among participants receiving nicotine as well as those in the sensorimotor deprivation condition. A nicotine X delivery interaction was found on negative affect (p\u3c.05), such that only within the natural delivery condition was negative affect lower among those who received nicotine than those who did not. There were main effects of nicotine on satisfaction and reward (ps\u3c.05), such that ratings were higher among those receiving nicotine. Results were similar when controlling for baseline withdrawal. Positive reinforcement expectancies significantly moderated delivery effects on satisfaction (p \u3c .01). In summary, inconsistent with the hypotheses, nicotine was implicated as the main driver of various subjective outcomes. Additionally, it may be that the novelty of our apparatus in the sensorimotor deprivation condition reduced cravings to smoke and vape via distraction. Clinical implications are discussed