Very Low Nicotine Content Cigarettes

At a glance

Most people who smoke want to quit. Nicotine is an addictive substance in cigarettes and other tobacco products. Cigarettes with very low nicotine levels may help people smoke less or quit. Quitting smoking completely is very important to protect health.

The bottom line

  • Nicotine is highly addictive and plays a dominant role in sustaining commercial tobacco use.
  • Using any commercial tobacco product is unsafe. Quitting smoking is very important to protect health.
  • Lowering nicotine to minimally addictive or nonaddictive levels in all cigarettes would help prevent people from smoking regularly and could also help people quit smoking.
  • Preventing and stopping tobacco use would reduce tobacco-related disease and death.

Very low nicotine content cigarettes

Nicotine is a highly addictive chemical found in tobacco products.12 Nicotine can harm the developing adolescent brain.23 It can lead to lifelong nicotine addiction and plays a dominant role in sustaining commercial tobacco use.

Cigarette companies have intentionally adjusted nicotine levels in cigarettes to promote addiction. These adjustments cause people to become addicted to cigarettes and keep smoking.4

Very low nicotine content cigarettes are cigarettes with nicotine levels so low they are minimally addictive or are not addictive.5

The public health impact of very low nicotine content cigarettes

Studies show that people who smoke cigarettes and switch to very low nicotine content cigarettes reduce the number of cigarettes they smoke each day.678 However, only reducing the number of cigarettes smoked each day, rather than quitting cigarettes completely, can still lead to serious health problems. Very low nicotine content cigarettes are still harmful. Quitting completely is the best way to protect health.92

Studies show that many people who smoke cigarettes and switch to very low nicotine content cigarettes try to quit smoking, and many are successful.10111213

Studies have found there is support for reducing nicotine in cigarettes to minimally addictive or nonaddictive levels, including among adults who smoke and those who want to quit.14151617

Very low nicotine content cigarettes could be more effective at helping people quit if all cigarettes on the market had very low levels of nicotine.17 In addition, research suggests that if all cigarettes on the market had very low levels of nicotine, they may be even more effective at helping people quit if there were no menthol-flavored low-nicotine cigarettes.17

In 2022, the U.S. Food and Drug Administration (FDA) announced it would develop a proposed rule establishing a maximum nicotine content level in cigarettes and certain other combusted tobacco products, to make those products less addictive.18

Reducing the nicotine in cigarettes to minimally addictive or nonaddictive levels could help prevent people who experiment with cigarettes from becoming dependent on nicotine and transitioning to regular use. Reducing the nicotine levels in cigarettes to minimally addictive or nonaddictive levels also could help people quit smoking. This strategy should be even more effective when combined with public education campaigns that explain the reasons for the policy and when proven smoking cessation treatments—behavioral counseling and FDA-approved medications—are provided to help people quit.192017 Helping people quit using tobacco products completely offers the best protection from tobacco-related death and disease.

Print
Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. Apelberg BJ, Feirman SP, Salazar E, et al. Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States. N Engl J Med. 2018;378(18):1725–1733.
  2. U.S. Dept of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention; 2014. Accessed July 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK179276/
  3. U.S. Food and Drug Administration. Tobacco Product Standard for Nicotine Level of Combusted Cigarettes. 83 Fed. Reg. 11,818. March 16, 2018. Accessed July 18, 2024.https://www.federalregister.gov/documents/2018/03/16/2018-05345/tobacco-product-standard-for-nicotine-level-of-combusted-cigarettes
  4. United States v. Philip Morris USA, Inc. 449 F.Supp.2d 1 (D.D.C. 2006). Accessed July 18, 2024. https://casetext.com/case/us-v-philip-morris-usa-inc-ddc-2005
  5. Benowitz NL, Henningfield JE. Establishing a Nicotine Threshold for Addiction. The Implications for Tobacco Regulation. N Engl J Med. 1994 Jul 14;331(2):123–125.
  6. Puljevic C, Feulner L, Hobbs M, et al. Tobacco Endgame and Priority Populations: A Scoping Review. Tob Control. 2023:tc-2022-057715.
  7. Puljevic C, Morphett K, Hefler M, et al. Closing the Gaps in Tobacco Endgame Evidence: A Scoping Review. Tob Control. 2022;31:365–375.
  8. Shiffman S, Kurland BF, Scholl SM, Mao JM. Nondaily Smokers’ Changes in Cigarette Consumption with Very Low-Nicotine-Content Cigarettes: A Randomized Double-blind Clinical Trial. JAMA Psychiatry 2018;75(10):995–1002.
  9. U.S. Dept of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention; 2020. Accessed July 18, 2024. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf
  10. Donny EC, Denlinger RL, Tidey JW, et al. Randomized Trial of Reduced-Nicotine Standards for Cigarettes. N Engl J Med. 2015;373(14):1340–1349.
  11. Foulds J, Veldheer S, Pachas G, et al. The Effects of Reduced Nicotine Content Cigarettes on Biomarkers of Nicotine and Toxicant Exposure, Smoking Behavior and Psychiatric Symptoms in Smokers with Mood or Anxiety Disorders: A Double-Blind Randomized Trial. PLoS One. 2022;17(11):e0275522.
  12. Hatsukami DK, Kotlyar M, Hertsgaard LA, et al. Reduced Nicotine Content Cigarettes: Effects on Toxicant Exposure, Dependence and Cessation. Addiction. 2010;105(2):343–355.
  13. Higgins ST, Tidey JW, Sigmon SC, et al. Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials. JAMA Netw Open. 2020;3(10):e2019311.
  14. Ali FRM, Al-Shawaf M, Wang TW, King BA. U.S. Adults' Attitudes Toward Lowering Nicotine Levels in Cigarettes. Am J Prev Med. 2019;57(3):403–407.
  15. Denlinger-Apte RL, Koopmeiners JS, Tidey JW, et al. Support for a Nicotine Reduction Policy Among Participants Enrolled in a 20-week Trial of Very Low Nicotine Content Cigarettes. Addict Behav. 2021;114:106727.
  16. Fairman RT, Cho YJ, Popova L, et al. Support for Nicotine Reduction in Cigarettes: Findings from the 2016 and 2020 ITC Four Country Smoking and Vaping Surveys. Tob Control. 2023:tc-2023-058128.
  17. U.S. Dept of Health and Human Services. Eliminating Tobacco-Related Disease and Death: Addressing Disparities—A Report of the Surgeon General. U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2024.
  18. U.S. Food and Drug Administration. FDA news release: FDA announces plans for proposed rule to reduce addictiveness of cigarettes and other combusted tobacco products. Updated June 21, 2022. Accessed July 18, 2024. https://www.fda.gov/news-events/press-announcements/fda-announces-plans-proposed-rule-reduce-addictiveness-cigarettes-and-other-combusted-tobacco
  19. Benowitz NL, Nardone N, Dains KM, et al. Effect of Reducing the Nicotine Content of Cigarettes on Cigarette Smoking Behavior and Tobacco Smoke Toxicant Exposure: 2-year Follow Up. Addiction. 2015;110(10):1667–1675.
  20. Hatsukami DK, Donny EC, Koopmeiners JS, Benowitz NL. Compensatory Smoking from Gradual and Immediate Reduction in Cigarette Nicotine Content. Cancer Epidemiol Biomarkers Prev. 2015;24(2):472–476.