Should Nicotine Content of Cigarettes Be Reduced Gradually or Suddenly? Interview with:

Dorothy K. Hatsukami, Ph.D. Forster Family Professor in Cancer Prevention Professor of Psychiatry Associate, Director Masonic Cancer Center University of Minnesota

Dr. Hatsukami

Dorothy K. Hatsukami, Ph.D.
Forster Family Professor in Cancer Prevention
Professor of Psychiatry
Associate, Director Masonic Cancer Center
University of Minnesota What is the background for this study? What are the main findings?

Response: The U.S. Food and Drug Administration is considering a rule that would reduce nicotine in all cigarettes and possibly other burned tobacco products sold in the U.S. to minimally addictive levels.   Reducing nicotine in cigarettes does not make the cigarette safer, but because nicotine is the addictive chemical in tobacco, nicotine reduction would reduce the progression towards tobacco dependence and make it easier for smokers to quit smoking.  We recently published a study in JAMA that adds to the accumulating evidence to support reducing nicotine in cigarettes and addresses if a gradual reduction or a targeted immediate reduction in nicotine in cigarettes is the best approach.

In a large clinical trial involving 1,250 smokers across 10 academic institutions, immediate reduction of nicotine was compared to a gradual nicotine reduction approach. These two groups were also compared to smokers who continued to smoke usual nicotine content cigarettes.

Key findings showed that immediate nicotine reduction is likely to result in more rapid positive public health effects.  That is, smokers in the immediate reduction group experienced significantly less exposure to toxic cigarette smoke chemicals and reported smoking fewer cigarettes per day, less dependence on cigarettes and greater number of days that they were smoke-free compared to the other two groups. On the other hand, smokers in the immediate nicotine reduction group experienced more severe but transient withdrawal symptoms and greater drop-outs. What should readers take away from your report?

Response: The best approach for reducing nicotine in cigarettes and other combustible tobacco products sold in the U.S. will likely be a substantial nicotine reduction on a targeted date.  This approach would have a more immediate public health benefit and has the potential to prevent millions of premature tobacco-related deaths. However for smokers who are addicted, alternative sources of nicotine that are considered less harmful, such as medicinal nicotine gum and lozenges, should be readily available to smokers who would like or need to seek other sources of nicotine. What recommendations do you have for future research as a result of this work?

Response: We are conducting research that examines what types of alternative nicotine sources are sought by smokers who are assigned to minimally addictive cigarettes and the potential effects on health. Is there anything else you would like to add?

Response: No disclosures.  The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. 


Hatsukami DK, Luo X, Jensen JA, et al. Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke ExposureA Randomized Clinical TrialJAMA. 2018;320(9):880–891. doi:10.1001/jama.2018.11473


Sep 6, 2018 @ 1:40 am

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