# A Comparison of Electronic Cigarettes and Combination Nicotine Replacement Therapy among Individuals with Obesity who Smoke

> **NIH NIH P20** · BROWN UNIVERSITY · 2024 · $239,250

## Abstract

PROJECT SUMMARY
Individuals who smoke cigarettes with obesity (SWO) carry a disproportionate burden of tobacco-related
disease and death due to the interactive effects of smoking and excess weight. Smoking increases insulin
resistance and central adiposity (i.e., abdominal obesity), increasing the risk of metabolic syndrome, diabetes,
and cardiovascular disease (CVD). Consequently, SWO have 10x the risk of mortality from CVD relative to
normal weight nonsmokers. SWO are more likely than normal weight smokers to report using cigarettes to
manage their weight, to be concerned about gaining weight post-cessation, to have less confidence in their
ability to manage their weight without cigarettes, and to resume smoking if they gain too much weight while
quitting. This can result in reduced likelihood of attempting to quit and limited success with cessation when a
quit attempt is made. Research has suggested that getting smokers who have not been able to quit smoking to
switch from combustible cigarettes to electronic cigarettes (EC) could reduce morbidity and mortality. While
FDA-approved nicotine replacement therapy (NRT) is another option to facilitate changes in smoking,
adherence and acceptability tend to be low. In contrast, EC have been designed to deliver nicotine in bursts
that mimics smoking. Behaviorally and pharmacologically, EC may be a better substitute for smoking, leading
to higher compliance and helping to prevent cessation-related weight gain. While both NRT and EC may
reduce cigarette use in SWO, their efficacy, acceptability, and potential to limit weight gain and improve health
has not been compared among SWO. This research project (RP) will randomize 60 SWO to receive (1) EC, (2)
NRT, or (3) to a no-product control (CON) condition for 8 weeks. Assessments will occur at baseline, and 1, 2,
and 3-months follow-up. In a sample of SWO, aims include: 1) To compare EC, NRT, and CON on smoking,
exhaled carbon monoxide, and quit attempts; 2) To compare EC and NRT on acceptability and adherence; 3)
To compare EC, NRT, and CON effects on weight, central adiposity, glucose regulation, lipid metabolism,
inflammation, and blood pressure at follow-up. Prospective clinical studies are needed to understand whether
NRT or EC result in harm reduction by facilitating a switch from cigarettes to an alternate product, reducing
cigarette smoking, or by aiding in smoking cessation. This study will be the first to examine the effects of EC
and NRT on smoking and health among SWO. These findings add important knowledge about some of the
potential effects of EC and NRT use on use of combustible cigarettes and indicators of potential health harm in
a population highly vulnerable to smoking-related morbidity and mortality. The CADRE Cores will support the
successful completion of the RP and the investigator’s path to research independence. The REACH Core will
assist with remote participant recruitment, the CLC Core will provide clinical, technical, and scien...

## Key facts

- **NIH application ID:** 10849987
- **Project number:** 2P20GM130414-06
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Cara Murphy
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $239,250
- **Award type:** 2
- **Project period:** 2019-08-01 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10849987

## Citation

> US National Institutes of Health, RePORTER application 10849987, A Comparison of Electronic Cigarettes and Combination Nicotine Replacement Therapy among Individuals with Obesity who Smoke (2P20GM130414-06). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10849987. Licensed CC0.

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