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Switching people who smoke to unfiltered cigarettes: perceptions, addiction and behavioural effects in a cross-over randomised controlled trial
  1. Kim Pulvers1,
  2. LaRee Tracy2,
  3. Thomas E Novotny2,
  4. Nora Satybaldiyeva2,
  5. Adam Hunn2,
  6. Devan R Romero3,
  7. Nathan G Dodder2,4,
  8. Jose Magraner2,
  9. Eyal Oren2
  1. 1 Department of Psychology, California State University San Marcos, San Marcos, California, USA
  2. 2 School of Public Health, San Diego State University, San Diego, CA, USA
  3. 3 Department of Kinesiology, California State University San Marcos, San Marcos, California, USA
  4. 4 San Diego State University Research Foundation, San Diego, CA, USA
  1. Correspondence to Dr Kim Pulvers, Department of Psychology, California State University San Marcos, San Marcos, CA 92096, USA; kpulvers{at}


Background Behavioural research is needed to inform a ban on sales of filtered cigarettes that could reduce plastic waste due to discarded filters. This study reports on differences in perceptions, nicotine dependence and behaviour among participants in a cross-over randomised trial of filtered compared with unfiltered cigarettes.

Method This proof-of-concept study involved 43 people who smoke filtered cigarettes (41.9% women, mean age 36.7 years). Participants were provided 2 weeks’ supply of filtered cigarettes, 2 weeks of the same brand of unfiltered cigarettes and randomly assigned to starting conditions. Measures included the Modified Cigarette Evaluation Questionnaire; single-item cigarette perception questions; Fagerström Test of Nicotine Dependence; 7-day cigarette consumption, urinary cotinine and intention to quit. Analyses included linear and ordinal repeated measures mixed-effects models and paired t-tests.

Results Filtered cigarettes were perceived as better tasting, more satisfying, more enjoyable, less aversive, less harsh, less potent and less negatively reinforcing than unfiltered cigarettes. Filtered cigarettes were smoked at a higher rate during the trial than unfiltered cigarettes (p<0.05). There was no difference in cotinine, dependence or intention to quit between filtered versus unfiltered cigarette conditions (p>0.05).

Conclusion People who smoke perceived unfiltered cigarettes as having greater nicotine effects and less desirable sensory effects than filtered cigarettes, and they smoked fewer of these during the trial. Although cotinine, dependence and intention to quit were similar for smoking unfiltered and filtered cigarettes in this small trial, results suggest that banning the sale of filtered cigarettes might make smoking less attractive overall to people who smoke.

Trial registration number NCT03749876.

  • nicotine
  • addiction
  • environment
  • endgame

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  • Contributors All authors contributed substantively to the manuscript.

  • Funding This study was funded by California Tobacco Related Disease Research Program (28IP-0022S).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.