Very Low Nicotine Content Cigarettes and E-Cigarettes in Promoting Smoking Cessation in Daily and Intermittent Cigarette Smokers

Inclusion Criteria:

* Sign consent and agree to all study procedures
* Have an address where he/she can receive mail
* Have a device available to conduct telehealth visit (e.g., smartphone, computer, tablet, internet access, etc.)
* Able to follow verbal and written instructions in English
* Willing and able to complete two spirometry sessions (this criterion waived during COVID-19 pandemic)
* Be the only participant in their household
* Interested in trying novel nicotine products
* Daily smokers: \>= 1 cigarette/little cigar per day
* Intermittent smokers: \>= 1 cigarette/little cigar per day 4 to 27 days per month
* Agrees to comply with all MD Anderson institutional policies related to COVID-19 screening prior to each in-person research visit
* The individual agrees to not engage in study procedures or interactions with study personnel while operating a vehicle

Exclusion Criteria:

* Unwilling to refrain from other e-cigarette use for the duration of the study, other than what is provided to them for study purposes
* Current/recent use of certain medications:

  * Smoking cessation meds (past 90 days; e.g., wellbutrin, bupropion, Zyban, nicotine replacement therapy \[NRT\], Chantix)
  * Certain medications to treat depression (last 14 days; e.g., amitriptyline)
  * A case by case determination will be made by study physician for medication on the precautionary list, (e.g. nitroglycerin)
  * Self-reported daily use of opioids for 30 days or more on phone screen or at screening is exclusionary however pro re nata (PRN) use is allowed (e.g., 3 to 7 days per week or less or if more frequent, use less than a month's duration
* Unstable medical condition as determined by the medical team
* Self-reported bronchial or respiratory infection in the last 14 days (this criterion waived during COVID-19 pandemic)
* Subject's spirometry forced expiratory volume in 1 second (FEV1) percentage reading is \< 50 (severe to very severe obstruction) (this criterion waived during COVID-19 pandemic)
* Self-reported abnormal heart rhythms or cardiovascular disease (stroke, chest pain, heart attack) in the last 3 months
* Meet criteria for major depressive syndrome or suicidality on the Patient Health Questionnaire-9 (PHQ-9)
* Self report of past or current diagnosis of bi-polar disorder or schizophrenia/schizoaffective disorder
* Self-reported other tobacco use besides cigarettes or little cigars (e.g., hookah, cigarillos, smokeless tobacco, chewing tobacco, pipes, cigars, etc.) on 10 or more days in the last month
* Recent (past 90 days), current, or planned (within the next 45 days) involvement in smoking cessation activities
* Positive urine pregnancy test at screening. Women who are two years post-menopausal, or who have had a tubal ligation or a partial or full hysterectomy will not be subject to a urine pregnancy test
* Women that are breastfeeding or of childbearing potential and not protected by a medically acceptable, effective method of birth control while enrolled in the study. Medically acceptable contraceptives include:

  * Approved hormonal contraceptives (such as birth control pills, patches, implants or injections)
  * Barrier methods (such as condom or diaphragm) used with a spermicide, or
  * An intrauterine device (IUD)
  * Contraceptives sold for emergency use after unprotected sex are not acceptable methods for routine use
* Subject considered by the investigator to be unsuitable to participate in the study (e.g., due to cognitive deficits or instability to last the entire duration of the study)