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Reduced-nicotine cigarettes minimize nicotine exposure, number of cigarettes smoked

A notable reduction in nicotine content in cigarettes appeared to significantly reduce smoking, nicotine exposure and nicotine dependence in adults who smoke, according to results of a randomized, double blind clinical trial.

“These data suggest that if nicotine content is adequately reduced, smokers may benefit by smoking fewer cigarettes and experiencing less nicotine dependence, with few negative consequences,” Eric C. Donny, PhD, an associate professor in the department of psychology at University of Pittsburgh, and colleagues wrote. “If confirmed in longer-term studies, these findings suggest that, when combined with other tobacco-control policies, limiting the nicotine content of cigarettes in order to reduce cigarette use and nicotine dependence and facilitate efforts to quit smoking could improve public health.”

Donny and colleagues conducted a randomized, double blind trial to assess if reducing the level of nicotine in cigarettes would reduce the number of cigarettes participants smoked per day after 6 weeks.

The researchers randomly assigned 840 adults aged 18 years and older to smoke seven types of cigarettes that varied in nicotine content for 6 weeks. Study cigarettes included the participant’s usual brand, an investigational cigarette with 15.8 mg of nicotine per gram of tobacco, and investigational cigarettes with 5.2 mg, 2.4 mg, 1.3 mg, and 0.4 mg of nicotine per gram of tobacco.

Participants assigned to cigarettes containing 2.4 mg (n = 119; 16.5 per day), 1.3 mg (n = 119; 16.3 per day) and 0.4 mg of nicotine (n = 119; 14.9 per day) smoked significantly less than those assigned their usual brand (n = 118; 22.2 per day), as well as 15.8 mg (n = 119; 21.3 per day) (P < .001).

However, participants assigned to cigarettes with 5.2 mg of nicotine or less per gram reported smoking at least one non-study cigarette during the study more often than those assigned to the cigarettes with higher nicotine (73% - 81% vs. 57%; P < .005).

Smokers assigned to cigarettes with 5.2 mg of nicotine or less per gram had lower urinary total nicotine equivalents that those assigned to cigarettes with 15.8 mg of nicotine (P ≤ .01).

Some factors should be considered when assessing the data, according to the researchers.

The use of non-study cigarettes might have diminished the reduction in nicotine exposure and might have minimized the effects of nicotine reductions. Also, because the researchers provided free cigarettes, there is a possibility that increased the number of cigarettes smoked per day.

“The current study by Donny and colleagues adds to a growing literature supporting the feasibility and potential benefits of a national nicotine-reduction policy — one that, in our view, could help to end the devastating health consequences of combustible-tobacco use,” Michael Fiore, MD, MPH, and Timothy Baker, PhD, wrote in an accompanying editorial. “We believe these data support exploration of a national nicotine-reduction policy, and we recommend that additional attention be paid to low-nicotine cigarettes as a potential clinical smoking-cessation resource.” – by Ryan McDonald

Disclosure: Please see the full study for a list of all researchers’ relevant financial disclosures.