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Immediately quitting smoking is better than slowly stopping, study says

In a study published in JAMA, researchers investigated various levels of nicotine in cigarettes to discern its impact on individuals quitting smoking and overall health.

Nicotine, the physically addictive chemical found in cigarettes, is largely responsible for smoking-related disease and premature death. To reduce the burden of disease caused by smoking, the US Food and Drug Administration (FDA) proposed to minimize nicotine levels in cigarettes to evade approximately 8.5 million deaths by 2100. However, the reduction strategy to be implemented is still open for consideration.

As a result, Hatsukami and colleagues explored the health effects of an immediate or gradual reduction of cigarettes with varied nicotine levels. Their research sought to discern if waning nicotine strength progressively, or all at once, had the most impact upon health.

In the study published in JAMA, researchers recruited 1,250 smokers from 10 academic centers in the United States. They randomly distributed the participants into one of three conditions where they either underwent an immediate or gradual reduction of nicotine strength from 15.5 to 0.4 mg or maintained the customary amount, 15.5 mg of nicotine, over the five-month period.

Their results revealed that immediately reducing nicotine levels to 0.4 mg had the greatest impact on health. Harmful health effects, such as smoke toxicant exposure to carbon monoxide, which is typically experienced by habitual smokers, dramatically diminished. This signifies that immediately quitting smoking is better than gradually stopping.

When carbon monoxide is breathed into the lungs through cigarette smoking, it attaches to red blood cells. In consequence, oxygen is unable to bind to the blood cells, blocking blood from transporting oxygen to the body. Long-term exposure to carbon monoxide can lead to heart disease and cause death.

However, the immediate reduction of nicotine strength prompted a greater amount of withdrawal symptoms and caused higher dropout rates within the study. There a few limitations to the research. There was a high dropout rate, and the use of non-study cigarettes by many participants in the immediate reduction condition.

As a result, if the FDA does decide to implement this strategy, smokers would likely seek out alternative sources to satiate their nicotine addiction. Their study suggests executing nicotine replacement therapies to combat this issue. Immediately quitting smoking may have serious withdrawal concerns, but they can nevertheless be managed and controlled.

Read about the top 4 ways to quit smoking here.

Written by Helen Marzec


  1. Carbon Monoxide in Cigarettes. Retrieved from
  2. Boyles, S. (2018). Study: Cold Turkey Best for Cutting Cigarette Nicotine Content. Retrieved from
  3. Hatsukami, D. K., Luo, X., Jensen, J. A., al’Absi, M., Allen, S. S., Carmella, S. G., … &Koopmeiners, J. S. (2018). Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke Exposure: A Randomized Clinical Trial. JAMA320(9), 880-891.


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