A systematic review of 17 clinical trials found that smokers did not inhale more or smoke more cigarettes when using low-nicotine products.
RT’s Three Key Takeaways:
- No Compensatory Smoking: Researchers found that smokers switching to very low nicotine cigarettes did not increase their cigarette consumption or inhale more deeply to compensate for lower nicotine levels.
- Reduced Consumption: The analysis of 17 clinical trials showed that most participants actually smoked fewer cigarettes per day after switching to low-nicotine options compared to traditional cigarettes.
- Public Healthcare Impact: These findings support a proposed Food and Drug Administration product standard aimed at reducing nicotine in combusted tobacco to minimally addictive levels to help lower smoking rates.
People who switch to cigarettes with significantly reduced nicotine levels are unlikely to smoke more cigarettes or inhale more smoke to compensate for the lower nicotine content, according to a study published in JAMA Network Open,
The systematic review, led by researchers at Wake Forest University School of Medicine, examined 17 randomized clinical trials involving more than 5,500 adolescents and adults. Researchers found little evidence that smokers compensated for reduced nicotine by increasing their smoking behavior, according to the study data. Most participants actually smoked fewer cigarettes after switching to low nicotine.
The findings are relevant to a proposed FDA product standard that would reduce nicotine levels in cigarettes and certain other combusted tobacco products to minimally or nonaddictive levels. The proposed rule remains under FDA review.
“Cigarette smoking is at a historic low, a public healthcare victory, but that’s still 25 million people who smoke,” said Rachel Denlinger-Apte, PhD, MPH, assistant professor of social sciences and health policy at Wake Forest University School of Medicine.
Data from the CDC shows more than 40% of adults in the US smoked in the mid-1960s, a number that has dwindled to just under 10% in recent years.
Public healthcare efforts to further reduce smoking have recently included “very low nicotine content” cigarettes, which contain about 95% less nicotine than conventional cigarettes. Because nicotine is the addictive chemical in cigarettes, lowering nicotine levels could help prevent future generations from becoming dependent on tobacco and support people trying to quit by easing withdrawal symptoms, according to the researchers.
The study aimed to address concerns regarding “compensatory smoking,” a behavior often associated with “light” cigarettes developed decades ago. Unlike very low nicotine cigarettes, “light” cigarettes were not low in nicotine and relied on ventilated filters to dilute inhaled smoke, which often led smokers to inhale more deeply.
“Our findings suggest that widespread compensatory smoking is unlikely to occur if a low-nicotine product standard is implemented,” said Denlinger-Apte. “The concern has been that people would smoke more cigarettes or inhale more deeply to get the nicotine they are used to receiving. Across 17 clinical trials, we found minimal evidence that this happens.”
In the systematic review, Denlinger-Apte and colleagues examined clinical trials published between 2010 and 2024. They also performed an analysis using data from more than 2,400 smokers enrolled in seven US studies. They found that none of these trials reported increases in the number of average cigarettes smoked per day among people assigned to the very low nicotine cigarettes.
In 16 of the 17 trials, participants smoking low nicotine cigarettes actually smoked fewer cigarettes per day than those smoking traditional cigarettes, and many made spontaneous attempts to quit, according to the news release. Additional findings showed no evidence of reported increases in average carbon monoxide exposure. After six weeks, fewer than 1% of participants were predicted to smoke more.
“While smoking rates are down, the toll of tobacco use remains substantial, and there is still an urgent need for policies that help prevent nicotine addiction and support people who want to quit,” said Denlinger-Apte. “Modeling studies have suggested that a nationwide nicotine product standard could substantially reduce smoking over time, including by prompting millions of people to quit.”
