Reduced Nicotine Cigarettes: Smoking Behavior and Biomarkers of Exposure among Smokers Not Intending to Quit

Abstract

Background: The U.S. FDA has the authority to limit the nicotine content of cigarettes; however, there are concerns that reduced nicotine cigarettes will be smoked more intensely and, therefore, will increase exposure to toxic chemicals in smoke. This study examined changes in consumer behavior and exposure in response to cigarettes with substantially reduced nicotine content.Methods: Seventy-two adult smokers completed an unblinded trial of reduced nicotine cigarettes. Participants completed a 7-day baseline period during which they smoked their usual cigarette brand, followed by consecutive 7-day periods smoking cigarettes with progressively lower nicotine levels (0.6, 0.3, and 0.05 mg emission Quest cigarettes). Nicotine dependence and withdrawal, smoking behavior, and biomarkers of exposure were assessed for each 7-day period.Results: Significant reductions in nicotine intake were observed between usual brand smoking ($1.2 mg nicotine) and the 0.3 and 0.05 mg nicotine emission cigarettes, but not the 0.6 mg cigarette. The findings provide little evidence of compensatory smoking of Quest cigarettes, with no increases in exhaled breath carbon monoxide levels, smoking intensity, or levels of 1-hydroxypyrene across study periods. No significant differences were observed for smoking urges or measures of nicotine dependence.Conclusions: The study adds to the evidence that cigarettes with markedly reduced nicotine content are not associated with increased smoking intensity or exposure to smoke toxicants.Impact: The findings add to the evidence base on reduced nicotine content cigarettes and have the potential to inform FDA policy on nicotine levels. Cancer Epidemiol Biomarkers Prev; 23(10); 2032-40. Ó2014 AACR.

A Randomized Controlled Trial of Progressively Reduced Nicotine Content Cigarettes on Smoking Behaviors, Biomarkers of Exposure, and Subjective Ratings

“…At moderate nicotine content, smokers increased daily cigarette consumption but puffed less intensely; at very low nicotine content, smokers’ CPD and total puff volume were similar to use of their own cigarette brand. Harm exposure findings were equally complex: NNAL and cotinine decreased with cigarette nicotine content, but RNC period had no effect on 1-HOP, consistent with other studies (8,9,11–13,36). Further, CO boost increased at moderate nicotine content, but decreased during very low nicotine content.…”

“…Study findings explicate previous work by demonstrating that very low nicotine content cigarettes generally do not increase measures of harm exposure or negative smoking behaviors, despite diverging from prior research (8,9,11) regarding behavioral results at moderate nicotine content. Such discrepancies may be due to study differences in assessment of cigarette consumption (e.g., using spent filters to complement self-report may have increased accuracy over daily dairy methods prone to recall bias), or length of exposure to each nicotine level (e.g., 7-day (11), 1-week (8), and 1-month (9) periods).…”

“…FTC-determined yields were 0.6, 0.3, and 0.05 mg, respectively; rod nicotine content varies based on assessment methods, but was estimated to be 8.9, 5.1–8.4, and 0.48–1.5 mg nicotine per cigarette, respectively (11,20–22). The control group smoked their own brand across all periods.…”

“…While these findings, along with those of other, smaller RNC cigarette studies, are critically important in demonstrating that these products do not appear to increase harm, further research is required to more thoroughly assess the public health impact of RNC cigarettes. For example, brief use periods (10,14) and assessing behavior only through CPD (8,9), or with a single topography assessment (11), do not sufficiently capture the complexities and individual differences in smoking behavior. Further, because variations in smoking behavior can differentially affect exposure to carcinogenic cigarette constituents (17), a rigorous panel of biomarkers is needed to thoroughly characterize harm exposure (18).…”

Reducing the nicotine content of combusted tobacco products sold in New Zealand

“…Although smokers may attempt to compensate when they first try VLNC cigarettes, numerous studies have shown that most smokers do not compensate after the first few cigarettes5 34 35 and that biomarkers of smoke exposure do not increase when participants are switched to VLNC cigarettes 4 5 8 9 16 17. One limitation of clinical trials suggesting little or no compensation is that smokers could easily purchase normal nicotine cigarettes, although an inpatient study in which participants could only use VLNC cigarettes also demonstrated a reduction in smoke exposure 8.…”