MedPage Today’s contributing writer Molly Walker released an article on Oct. 1, 2015 on the results of a study done at the University of Pittsburgh to determine whether lowering the nicotine content of cigarettes would result in fewer cigarettes smoked. The study was not designed to encourage smoking cessation. This was a six week study on a population of regular smokers. The article is titled Reduced-Nicotine Cigarettes: Safer Than Conventional Products? Randomized trial shows mixed results.
The smokers were provided free cigarettes and the control group using the standard 15.8 mg of nicotine cigarette increased their consumption. Smokers with lower nicotine levels reduced the average number of cigarettes compared to the standard nicotine level by about three cigarettes per day from the baseline. A number of researchers commented on the study results with a general conclusion that lower nicotine levels in the cigarettes was not a major factor in smoking cessation.
The study results showed that 34.7% of the smokers at the lowest levels of nicotine (0.4 mg) attempted smoking cessation versus 17% for those in the standard nicotine level (15.8 mg) control group. These attempts at smoking cessation were driven by the participants since the study specifically was not focused on changing smoker’s habits during the brief trial. The lower nicotine levels reduced smoking levels by a small amount. Eliminating the free cigarettes would make the study more valid for comparing results across all of the five groups in the study.
Quotes from the MedPage Today article presented viewpoints that appear to miss several key results in the study.
MedPage Today clinical reviewer, Perry Wilson, MD, of Yale University, pointed out in a separate video commentary that study participants kept smoking their usual amount and getting “all that tar” despite the lower nicotine content.
In the end, separating tar and nicotine is a great idea, but maybe this study gets it backward. Instead of making cigarettes less appealing by reducing the nicotine content, perhaps we should find ways to deliver nicotine without all the tar.
Wilson also commented that his “hipster neighbor” had a way of getting nicotine without tar (through e-cigarettes) and wondered if allowing access to these safer ways to deliver nicotine was a sort of compromise.
However nicotine is delivered, nicotine is a major health risk. E-cigarettes potentially deliver a much higher volume of nicotine than standard cigarettes. Nicotine is a major cause of vascular constriction throughout the body. This constriction raises blood pressure and decreases circulation of blood to the heart, other major organs and limbs. Nicotine is a major factor in amputations of limbs, fingers and toes for diabetics. E-cigs impact lung function, with or without nicotine. An e-cig delivering 11 mg of nicotine significantly decreased lung functions based upon a Greek study published by the National Institute of Health.
Nicotine impacts the immune system causing increased risks for COPD, pneumonia, cancers of the liver, kidneys, and bladder. Dr. Wilson’s comments support e-cigarettes as an alternative to standard cigarettes, while ignoring the inherent dangers of nicotine and chemical byproducts produced when using e-cigarettes. Other contributors to the MedPage Today article reached different conclusions than Dr. Wilson.
Michael Fiore, MD, MPH, MBA, and Timothy Baker, PhD of the University of Wisconsin stated that reducing nicotine content would have a positive impact on public health.
We believe these data support exploration of a national nicotine-reduction policy, and we recommend that additional attention be paid to low-nicotine cigarettes as a potential clinical smoking-cessation resource.
Stanton Glantz, PhD, professor of medicine at the Center for Tobacco Control, Research & Education at the University of California at San Francisco, was not involved in performing the study. His comments were summarized regarding lower nicotine cigarettes.
It is not a ‘safer cigarette. What [the study] does show is that, all things being equal, if the FDA ordered cigarette companies to substantially reduce nicotine levels, it would move smokers toward quitting.
This six week study on the impact of lowering nicotine content on public health should be expanded through research funded by the FDA, NIH, or CDC. The studies should exclude funding by cigarette and e-cigarette manufacturers. The specific impact of nicotine on cancers throughout the body should be documented. The economic impact and health impact of nicotine consumption through all sources, including standard cigarettes, e-cigarettes, other tobacco products and nicotine-based insecticides should be documented. The assertion that nicotine does not contribute to cancer should be proven, or the warning labels on e-cigarettes should be altered.