Low-nicotine cigarettes: misperceptions may not lessen benefits

When cigarettes contain less nicotine, smokers see them as safer, because they equate the stimulant with smoking-related diseases. But that misperception doesn't cancel out the potential benefits of low-nicotine cigarettes, a new study suggests.

In fact, while nicotine is addictive, it doesn't lead to the health conditions caused by smoking. Heart attacks, lung cancer and respiratory conditions can be blamed on other cigarette additives like tar.

Last week, the U.S. Food and Drug Administration announced plans to begin a public dialogue about lowering nicotine levels in cigarettes to non-addictive levels.

But some experts fear people may smoke more, or be less likely to quit, if they believe low-nicotine cigarettes are safer, said Lauren Pacek, of Duke University in Durham, North Carolina.

Perceived nicotine content was indeed associated with perceived health risks in her team's study, as reported in the journal Tobacco Control. However, Pacek told Reuters Health, "on the positive side, we found perceived nicotine content wasn’t associated with smoking behavior."

Smokers still wanted to stop smoking within a year even if they believed low-nicotine cigarettes to be less risky than traditional smokes. The findings are drawn from participants in a 2015 study, in which people who smoked cigarettes with less nicotine ended up smoking less and having less exposure to nicotine.

For the six-week study, 839 daily smokers were randomly assigned to smoke either their usual cigarettes, or experimental cigarettes with varying levels of nicotine for six weeks.

Participants who smoked experimental cigarettes were unaware of the nicotine content. At the end of the study, about 34 percent thought they were smoking cigarettes with a very low nicotine level. About 36 percent thought the nicotine level was low, about 24 percent thought it was moderate and 6.8 percent thought it was high or very high.

Based on survey responses at the end of the study, Pacek and colleagues found that participants believed the health risks posed by the cigarettes increased with the level of nicotine.

But even if they believed that low-nicotine cigarettes are less harmful, people who thought they were smoking very low nicotine cigarettes were more likely to say they would quit within a year if those were the only cigarettes on the market, compared to people smoking cigarettes with low or moderate nicotine levels.

The study can't say definitively that seeing low-nicotine cigarettes as safer won't lead people to smoke more, said Pacek. Her team has conducted a follow-up study, to see "if over the longer term these thoughts make a difference," she said. "We should be able to dig into the data and look at that pretty soon."