A recent study determined the effect of reducing nicotine content gradually or immediately on the biomarkers of smoke exposure.
Earlier in 2018, the US Food and Drug Administration proposed a reduction of nicotine levels in various products. They aimed to elongate the time between an individual starting to smoke and dependence on nicotine. The proposition held several conflicts. One conflict was the potential for withdrawal symptoms. Immediate reduction of nicotine levels would cause regular smokers to experience withdrawal symptoms and rely on other sources to feed nicotine addictions, whereas a gradual decline in nicotine levels would prolong smoking cessation and continuously enable smoke exposure.
A study published by JAMA assessed the difference in the biomarkers of smoke exposure as a result of gradual nicotine reduction versus immediate nicotine reduction. The researchers conducted the study using 1250 participants across 10 locations within the US.
They randomly allocated each individual to one of the following categories: gradual nicotine reduction, immediate nicotine reduction, and a control group with regular nicotine intake. All participants were of legal age and identified as regular smokers consuming at least five cigarettes per day. Any individuals planning to quit smoking within the next 30 days were not included in the study.
The results were measured using primary outcomes such as expiration (outward flow of breath) and urinary content. The researchers also identified the number of cigarette-free days, white blood cell count, and total nicotine equivalents in urine. The study also considered factors such as the context of smoking, smoking intensity from cigarette filters, and intention to quit following the study.
The study concluded that there was a visible decline in levels of toxicant exposure in individuals in the immediate reduction group. The gradual reduction group did not experience a significant decline in toxicant exposure. An immediate reduction in nicotine levels also showcased lower levels of toxicant exposure than a gradual reduction in nicotine levels.
The researchers provided cigarettes free of cost to the participants and collected data over 20 weeks. The monetary drawback of a smoking habit, along with the long-term effects of withdrawal symptoms, was outside the scope of the study and would likely affect these outcomes.
While the study presents a viable argument for implementing an immediate reduction in nicotine levels, a long-term follow-up study with a larger sample size and more controlled parameters would be required to create a strong case for reducing nicotine levels in products, such as low-nicotine cigarettes.
Written by Shrishti Ahuja, HBSc
Reference: Hatsukami, D. K., Luo, X., Jensen, J. A., Al’Absi, M., Allen, S. S., Carmella, S. G., . . . Donny, E. C. (2018). Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke Exposure. Jama, 320(9), 880. doi:10.1001/jama.2018.11473