E-Cigarette Additives for Smoking Perceptions

(ICE Trial)

Overseen By The Ohio State Comprehensive Cancer Center

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University Comprehensive Cancer Center

Disqualifiers: Recent COVID-19, Cardiac event, Pregnancy, Serious lung disease, Bleeding disorder, Severe disability, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 4 sessions

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how synthetic cooling additives in e-cigarettes affect users' perceptions, usage patterns, and exposure to harmful substances. Participants will try various e-cigarette flavors, including fruit and tobacco, with and without these cooling agents. The trial seeks individuals aged 21-29 who have used e-cigarettes at least weekly over the past three months and can abstain from use for at least 12 hours before lab sessions. As an unphased study, this trial provides a unique opportunity to contribute to understanding the impact of e-cigarette additives on user experience and health.

Do I have to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that synthetic cooling agents like WS-3 and WS-23, found in some e-cigarette liquids, might be inhaled at levels higher than what's considered safe. This means users could be exposed to more of these agents than recommended. While safe in food, their safety when inhaled remains uncertain.

For fruit-flavored e-cigarettes without these agents, studies indicate that people often perceive them as less harmful than regular cigarettes. However, e-cigarettes can still release harmful chemicals and small amounts of metals when used.

Tobacco-flavored e-cigarettes also pose risks. They usually contain nicotine, which is addictive. Although some people believe vaping is safer than smoking regular cigarettes, it's important to remember that e-cigarettes are not without risks.

In summary, while e-cigarettes might seem like a safer option than smoking, they still present safety concerns, especially with high levels of synthetic cooling agents. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how additives in e-cigarettes can change people's perceptions of smoking. Unlike traditional options that focus on nicotine replacement or cessation programs, this study looks at how different e-liquid flavors and cooling agents might influence a smoker's experience. By examining fruit and tobacco-flavored e-cigarettes, both with and without synthetic cooling agents, the trial could reveal new insights into how flavor and sensory effects impact smoking behavior. This could potentially lead to more effective strategies for reducing smoking rates and improving public health.

What evidence suggests that this trial's treatments could be effective for smoking perceptions?

This trial will compare different e-cigarette flavors and additives. Research has shown that many e-cigarette users prefer synthetic cooling agents, such as WS-3 and WS-23. One study found that 78.4% of users favored cooling flavors, and 52.5% chose fruit-cooling flavors. People generally view these cooling agents positively, which might enhance the vaping experience. Participants in this trial may use fruit-flavored e-cigarettes, with or without synthetic cooling agents, or tobacco-flavored e-cigarettes, also with or without synthetic cooling agents. Users of fruit-flavored e-cigarettes often report greater satisfaction than those using tobacco flavors. Although tobacco-flavored e-cigarettes with cooling agents have been studied, concerns exist about safety if exposure levels become too high. Overall, these flavors could enhance the vaping experience and might help reduce traditional cigarette use. ^{2 6 7 8 9}

Who Is on the Research Team?

Alayna P. Tackett, PhD

Principal Investigator

Ohio State University Comprehensive Cancer Center

Are You a Good Fit for This Trial?

This trial is for individuals who use tobacco products, specifically those interested in or currently using e-cigarettes. Participants should be willing to provide feedback through surveys and allow collection of biological samples.

Inclusion Criteria

I agree to not use electronic cigarettes 12 hours before lab sessions.

Current exclusive e-cigarette (EC) user (defined as ≥ weekly use over the past 3 months)

Not currently using another tobacco/nicotine product (defined as no use in the past 6 months)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants attend 4 sessions where they receive 1 of 4 randomly assigned flavored e-cigarettes and engage in vaping, surveys, and biosample collection.

4 sessions

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Behavioral Intervention

Trial Overview The study is looking at the effects of synthetic cooling additives (WS-3 and WS-23) on how people perceive e-cigarettes, their usage habits, and exposure to harmful substances.

How Is the Trial Designed?

Group I: Fruit flavored e-cigarette with synthetic cooling agents added Active Control 3 Interventions

Synthetic cooling agents will be added to fruit flavored e-liquid for this condition.

Group II: Fruit flavored e-cigarette Active Control 3 Interventions

Fruit flavored e-liquid will be used for this condition.

Group III: Tobacco flavored e-cigarette Active Control 3 Interventions

Tobacco flavored e-liquid will be used for this condition.

Group IV: Tobacco flavored e-cigarette with synthetic cooling agents added Active Control 3 Interventions

Synthetic cooling agents will be added to tobacco flavored e-liquid for this condition.

Who Is Running the Clinical Trial?

Ohio State University Comprehensive Cancer Center

Lead Sponsor

Trials

350

Recruited

295,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

In a study of 726 young adults, those who exclusively used e-cigarettes felt more confident about quitting compared to those who used both e-cigarettes and other tobacco products, indicating different motivations and perceptions about quitting.

Participants identified social influences, stress, and withdrawal symptoms as major barriers to quitting, highlighting the need for tailored cessation interventions that address these challenges and improve risk perceptions about tobacco use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: How can we reach them? Le, D., Ciceron, AC., Romm, KF., et al.[2023]

In a study of 109 patients who struggled to quit smoking using e-cigarettes, only 5.5% managed to quit temporarily, highlighting the challenges of e-cigarette dependence.

However, after receiving pharmacological treatment and behavioral/cognitive training, 43.1% of participants successfully quit smoking, indicating that these interventions can significantly improve cessation rates for those who did not succeed with e-cigarettes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Behavioral and Pharmacological Smoking Cessation Treatment in Patients with Failed Attempt at Quitting with E-cigarettes. Duru Çetinkaya, P., Turan, A., Deniz, PP.[2021]

Many smokers overestimate the health risks of nicotine, believing it to be a major cause of smoking-related diseases, which affects their attitudes towards nicotine replacement therapy (NRT) and e-cigarettes.

Intervention messages aimed at correcting nicotine misperceptions successfully reduced the perceived harm of nicotine and significantly lowered the intention to use e-cigarettes, but did not impact attitudes towards NRT.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Dilemma of Correcting Nicotine Misperceptions: Nicotine Replacement Therapy versus Electronic Cigarettes. Shi, R., Feldman, R., Liu, J., et al.[2022]

In a study of 35 adult daily smokers, the availability of e-cigarettes led to a significant 37% reduction in daily cigarette consumption, regardless of the nicotine content in the e-cigarettes.

Nicotine-containing e-cigarette cartridges resulted in greater usage and reduced cravings compared to non-nicotine cartridges, suggesting that while e-cigarettes can help reduce smoking, higher nicotine levels may enhance their appeal and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand. Tucker, MR., Laugesen, M., Bullen, C., et al.[2019]

The study developed and validated 21 brief measures to assess various e-cigarette risk perceptions, including absolute health risks and risks compared to cigarettes and nicotine replacement therapy, based on a survey of 1,642 participants.

These measures demonstrated reliability and validity, showing that higher risk perceptions were linked to lower current e-cigarette use and greater intentions to quit, making them useful tools for public health research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing and Validating Measures of Absolute and Relative E-Cigarette Product Risk Perceptions: Single Items Can Be Surprisingly Comprehensive. O'Brien, EK., Baig, SA., Persoskie, A.[2022]

Intensive multicomponent behavioral interventions can lead to long-term smoking cessation rates of nearly 50%, highlighting their effectiveness compared to other methods.

Nicotine replacement therapies, such as gum and patches, significantly enhance smoking cessation outcomes, with patches being easier for patients to use correctly.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Smoking cessation products and programs. Lando, HA.[2007]

Behavioral treatments for tobacco use are effective and cost-effective, comparable to pharmacotherapies, but have not advanced as quickly in recent years.

There is a need for more research on tobacco cessation interventions specifically for cancer patients, and clinicians are encouraged to use the Five A's approach to support these patients in quitting smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral tobacco cessation treatments: yesterday's news or tomorrow's headlines? Brandon, TH.[2007]

Health professionals can significantly improve patient outcomes related to tobacco use by implementing ten practical recommendations that enhance the delivery of tobacco interventions in clinical settings.

These recommendations focus on integrating tobacco treatment into routine clinical workflows, emphasizing the importance of evidence-based treatments, and ensuring that every patient encounter is an opportunity for intervention, ultimately aiming to reduce social disparities among tobacco users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems. Woods, SS., Jaén, CR.[2010]

In a study involving 127 dual users of e-cigarettes, nicotine delivery was found to significantly reduce cravings for smoking, highlighting its role in the efficacy of e-cigarettes for smoking cessation.

Interestingly, participants using an altered sensorimotor apparatus reported greater craving reduction than those using normal e-cigarettes, suggesting that the sensory experience of vaping may be less critical for experienced users than previously thought.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Distinct influences of nicotine and sensorimotor stimuli on reducing cravings to smoke and vape among dual users. Palmer, AM., Sawyer, LE., Brandon, TH.[2022]

This pilot study involves 60 COPD patients and compares the effectiveness of standard smoking cessation care (counseling and nicotine replacement therapy) with counseling plus electronic cigarettes (EC) over 12 weeks, aiming to identify barriers and facilitators to EC use.

The study seeks to assess the feasibility and acceptability of EC as a harm reduction strategy, with the potential to help COPD patients reduce their cigarette consumption or quit smoking altogether, addressing a significant health need for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial. Stevens, ER., Lei, L., Cleland, CM., et al.[2022]

A meta-analysis of 18 studies involving 3756 papers found no significant difference in the rates of adverse events (AEs) like cough, oral irritation, and nausea between nicotine electronic cigarettes (ECs) and nicotine replacement therapies (NRTs).

The similar incidence of AEs suggests that the preference for nicotine ECs over NRTs is not driven by differences in adverse effects, indicating a need for further research to explore other factors influencing user choices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Common adverse events of electronic cigarettes compared with traditional nicotine replacement therapies: A systematic review and meta-analysis. Anandan, AS., Leung, J., Chan, GCK., et al.[2023]

Nicotine replacement therapies have been shown to be effective in helping smokers quit, supported by large sample sizes and robust evaluation methods in the research.

There is no consistent evidence that one psychological treatment method is superior to others for smoking cessation, but intensive clinic-based treatments and brief community-oriented interventions are both important approaches, with the latter being more scalable for reducing overall smoking prevalence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatments for smokers. Hajek, P.[2019]

Nicotine replacement therapy (NRT) and sustained-release bupropion (bupropion SR) are effective pharmacotherapies for smoking cessation, increasing quit rates by 1.5 to over 2 times when combined with behavioral interventions.

National and international guidelines recommend systematic approaches for smoking cessation, including identifying smokers, assessing their readiness to quit, providing supportive advice, and administering approved therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Current approaches to the management of smoking cessation. Sutherland, G.[2018]

A significant majority of smokers and recent ex-smokers in the UK (57.3% for e-cigarettes and 63.4% for nicotine replacement therapy) perceive these alternatives as less harmful than traditional smoking, indicating a general awareness of their reduced risk.

However, misconceptions persist, particularly among those who have never vaped and those with inaccurate knowledge about nicotine, leading to concerns about e-cigarettes related to research gaps, regulation, and chemical safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Harm perceptions of e-cigarettes and other nicotine products in a UK sample. Wilson, S., Partos, T., McNeill, A., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7542635/

The Association of E-cigarette Flavors With Satisfaction ... Vapers using candy (41.0%, p < .0001) or fruit flavors (26.0%, p = .01) found vaping more satisfying (compared with smoking) than vapers using tobacco flavor ( ...

2. fda.gov fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey-nyts

Results from the Annual National Youth Tobacco Survey ... The findings showed current e-cigarette use decrease from 2.13 million (7.7%) youth in 2023 to 1.63 million (5.9%) youth in 2024. Furthermore, ...

3. bmcpublichealth.biomedcentral.com bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-21897-z

The role of sweet/fruit-flavored disposable electronic ... This systematic review analyzes findings from four heterogenous US studies. All analyzed studies highlighted that sweet/fruit-flavored ECs, ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2766787

Flavored e-Cigarette Uptake and Subsequent Smoking ... In this study, adults who vaped flavored e-cigarettes were more likely to subsequently quit smoking than those who used unflavored e-cigarettes.

5. sciencedirect.com sciencedirect.com/science/article/pii/S2772724622000464

Preferences, use, and perceived access to flavored e- ... Most past 30-day users (70%) and non-users (63%) perceived it would be somewhat or very easy to acquire e-cigarettes in flavors they like. Latent class analysis ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5049876/

Flavorings and Perceived Harm and Addictiveness of E- ... Ever and current e-cigarette users had higher odds of reporting that flavored e-cigarettes were “less harmful” than non-flavored e-cigarettes.

7. ourworldindata.org ourworldindata.org/vaping-vs-smoking-health-risks

Is vaping less harmful than smoking, and does it help ... Vapes also contain solvents and flavorings that can create harmful byproducts, and small amounts of metals can be released from the heating coil ...

8. bmcpublichealth.biomedcentral.com bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14166-w

E-cigarette addiction and harm perception: Does initiation ... Traditionally flavored e-cigarette initiation produces similar risk for addiction and harm perceptions as non-traditionally flavored initiation.

9. nature.com nature.com/articles/s41598-020-77452-w

Addressing the challenges of E-cigarette safety profiling by ... We compared two popular mixed fruit flavored ECIG-liquids with and without nicotine aerosolized at 40 W (E-smoke) with respect to particle ...