The article in JAMA Psychiatry by Shiffman et al1 titled “Nondaily Smokers’ Changes in Cigarette Consumption With Very Low-Nicotine-Content Cigarettes: a Randomized Double-blind Clinical Trial” is important on 2 fronts. First, the results provided evidence that nondaily or intermittent smokers, who comprise 25% to 33% of smokers, are nicotine seeking even though they typically do not show signs of physical dependence on cigarettes. As such, nondaily cigarette smokers assigned to smoke very low-nicotine-content cigarettes reduced their cigarette smoking by 51%. Why are these findings important? In March 2018, the US Food and Drug Administration made a bold move for public health and issued an Advanced Notice of Proposed Rulemaking to reduce the levels of nicotine in cigarettes (and possibly other combusted tobacco products) to minimally addictive levels. Reducing nicotine, the primary constituent that causes addiction, in cigarettes to render them nonaddictive has the potential to reduce the progression from experimentation to dependence and to facilitate abstinence, thereby substantially reducing the prevalence of smoking. This approach to tobacco control was introduced in 19942 but remained dormant until the passing of the Family Smoking Prevention and Tobacco Control Act, which gave the US Food and Drug Administration jurisdiction over the regulation of tobacco products. Since this act, research on the effects of reduced-nicotine-content cigarettes has burgeoned, including the study by Shiffman et al.1
Hatsukami DK. Reducing Nicotine in Cigarettes to Minimally Addictive Levels: A New Frontier for Tobacco Control. JAMA Psychiatry. 2018;75(10):987–988. doi:10.1001/jamapsychiatry.2018.1829
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