Cigarettes deliver nicotine at a rate and in a manner of dosing that maximizes the bioavailability of nicotine and provides significantly greater consumer appeal than pharmaceutical or non-combustible tobacco products. Despite increasing regulation of how cigarettes are marketed and where they can be used, the nicotine content has changed very little in the past 50 years. As a result, cigarettes are equally or more addictive today than ever before.
Toxic exposure from reduced nicotine content cigarettes: The Quest study
Although there is general consensus that cigarettes with significantly lower nicotine content would be less addictive and rewarding to use, there are concerns that toxic exposure may increase among those who continue to smoke reduced-nicotine cigarettes. Research with conventional cigarettes demonstrates that individuals smoke to achieve a desired nicotine dose and will adjust their smoking behavior to maintain this dose across products.In other words, smokers “compensate” for lower nicotine levels in the smoke by increasing the intensity of their puffing behavior and inhaling a greater volume of smoke. Because all conventional cigarettes have ample levels of nicotine in the tobacco, this is a relatively straightforward task for most smokers. Indeed, tobacco companies have invoked the compensatory argument in their submissions to government in an effort to oppose nicotine regulation.
We conducted a randomized clinical trial to examine use 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 (.6mg, .3mg, and .05mg Quest cigarettes). Nicotine dependence and withdrawal, smoking behavior, and biomarkers of exposure were assessed for each 7-day period. We observed significant reductions in nicotine intake were observed between usual brand smoking (~1.2mg nicotine) and the .3mg and .05mg, but not the .6mg 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. Overall, 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.
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Mouth-level intake of benzo[a]pyrene from reduced nicotine cigarettes
Cigarette smoke is a known source of exposure to carcinogenic polycyclic aromatic hydrocarbons (PAHs), especially benzo[a]pyrene (BaP). Exposure to BaP in cigarette smoke is influenced by how a person smokes and factors, such as tobacco blend. To determine whether sustained use of reduced-nicotine cigarettes is associated with changes in exposure to nicotine and BaP, levels of BaP in spent cigarette filter butts were correlated with levels of BaP in cigarette smoke to estimate mouth-level intake (MLI) of BaP for 72 daily smokers given three progressively reduced nicotine content cigarettes. Urinary cotinine, a marker of nicotine exposure, and urinary 1-hydroxypyrene (1-HOP), a marker of PAH exposure, were measured throughout the study. Median daily BaP MLI and urine cotinine decreased in a similar manner as smokers switched to progressively lower nicotine cigarettes, despite relatively constant daily cigarette consumption. 1-HOP levels were less responsive to the use of reduced nicotine content cigarettes. We demonstrate that spent cigarette filter butt analysis is a promising tool to estimate MLI of harmful chemicals on a per cigarette or per-day basis, which partially addresses the concerns of the temporal influence of smoking behavior or differences in cigarette design on exposure.
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Consumer demand for reduced nicotine cigarettes
We recently conducted a study with smokers in the Netherlands to assess consumer demand for reduced nicotine content cigarettes, and perceptions of pack claims of low nicotine using a discrete choice experiment. The study was conducted to anticipate the introduction of reduced nicotine content cigarettes on the European market. The findings will be publicly available soon.
