According to the Centers for Disease Control and Prevention (CDC), around 42.1 million American adults smoke cigarettes. It is the leading cause of preventable death in the country.
Nicotine is the main addictive component in tobacco smoke, responsible for both the rewarding feeling that cigarettes give smokers and the feelings of withdrawal that arise when the habit is stopped. Nicotine is also considered to be one of the most difficult substances to give up.
The authors of a new study, published in Cancer Epidemiology, Biomarkers & Prevention, state that previous research has found that smokers aim to "achieve a desired nicotine dose and will adjust their smoking behavior to maintain this dose across products."
If smokers are using reduced-nicotine cigarettes, the fear is that they would begin to smoke more in order to achieve their desired nicotine dose, and so increase their exposure to the other harmful components of cigarettes, such as tar and carbon monoxide.
With their recent study, the authors aimed to examine the changes in smoking behavior that arose with the smoking of reduced-nicotine cigarettes, and whether compensatory smoking occurred as a result. They also set out to investigate whether reduced-nicotine cigarettes affected smokers' exposure to nicotine and nicotine withdrawal symptoms.
Changing the habit
The researchers recruited participants for their study using newspaper advertisements in the Kitchener-Waterloo area of Ontario, Canada. The participants were aged between 18-65 years, smoked at least five cigarettes a day and had no intention to stop smoking within the next month. In total, 72 participants were recruited and completed the study.
After filling out smoking history and demographic data surveys, the participants smoked their normal brand of cigarettes for 1 week. For each of the following 3 weeks, the participants had to smoke different types of Quest reduced-nicotine cigarettes. Urine and breath samples were taken from the participants at the end of each week.
In the first week, Quest 1 cigarettes with a nicotine emission level of 0.6 mg were smoked. Quest 2 cigarettes were smoked the following week, with a nicotine emission level of 0.3 mg. In the final week, participants smoked Quest 3 cigarettes with a nicotine emission level of 0.05 mg.
In contrast, regular cigarettes normally have a nicotine emission level of around 1.2 mg.
The researchers found that, irrespective of brand, the participants did not change the number of cigarettes they smoked, nor the number of puffs they took from each one, during each week of the study.
They also recorded no difference in the post-cigarette carbon monoxide levels in the participants' breath and no difference in their urinary levels of 1-hydroxypyrene, a potential carcinogen found within cigarettes.
Levels of cotinine in the participants' urine fell by 34% and 55% during the smoking of Quest 2 and Quest 3 cigarettes. Cotinine is a breakdown product of nicotine that is often used to estimate nicotine levels.
Could these findings inform future policy?
The study is marked by certain limitations. The researchers were unable to monitor the participants' compliance precisely, and 44% of the participants reported smoking non-Quest cigarettes during the final week of the study.
The Quest cigarettes used in the study also contained a different tobacco to that found in most Canadian cigarettes, which may have meant that the participants' patterns of smoking were affected by them making adjustments to smoking a new kind of cigarette.
Despite these limitations, the researchers believe that their findings could prove useful to policy-makers, especially considering the powers held by the US Food and Drug Administration (FDA) following the 2009 Family Smoking Prevention and Tobacco Control Act.
David Hammond, one of the study's authors, mentions that the FDA now has a mandate "to reduce nicotine levels in cigarettes to negligible amounts."
"Our study suggests that smokers are unable or unwilling to compensate when there is markedly less nicotine in the cigarette and when the experience of smoking is far less rewarding. Our study may help regulators anticipate the possible consequences of mandatory nicotine reductions in cigarettes."
Previously, Medical News Today reported on a study that found there may be an association between high cigarette taxes and low suicide rates.