Reduced nicotine content cigarettes and use of alternative nicotine products: exploratory trial

Addiction. 2017 Jan;112(1):156-167. doi: 10.1111/add.13603. Epub 2016 Nov 2.


Aims: To compare the use of alternative nicotine products, smoking behavior and tobacco biomarker exposure in smokers unwilling to quit who were assigned randomly to normal nicotine content (NNC) cigarettes or very low nicotine content (VLNC) cigarettes.

Design: Randomized, parallel-arm 8-week study with assignment to VLNC (VLNC 1, n = 53) or NNC (NNC, n = 27) with access to non-cigarette combusted and non-combusted tobacco/nicotine products or to VLNC with access to only non-combusted products (VLNC2, n = 56).

Setting: Clinics in Minnesota, USA.

Participants: Smokers uninterested in quitting smoking with a mean [± standard deviation (SD)] age of 44 (± 14) years and smoking 16 (± seven) cigarettes/day; 51% female, 72% white.

Measurements: During the experimental period, the measures taken included: rate of alternative products used, amount of and abstinence from combusted tobacco used and tobacco exposure biomarkers.

Findings: There were higher rates of non-combusted alternative tobacco/nicotine product use in both VLNC conditions versus the NNC condition [rate ratio (RR) = 2.18, 95% confidence interval (CI) = 1.94, 2.46 and RR = 1.64, 95% CI = 1.46, 1.85, respectively] and in VLNC1 versus VLNC2 condition (RR = 1.33, 95% CI = 1.23, 1.44), accompanied by reduced biomarkers of exposure primarily in VLNC2 condition compared to NNC condition (Ps < 0.05). Fewer combusted products were smoked at almost all visits (Ps ≤ 0.02) and there were higher rates of abstinence for both VLNC conditions compared with the NNC condition (VLNC1 versus NNC: RR = 9.96, 95% CI = 5.01, 19.81; VLNC2 versus NNC: RR = 11.23, 95% CI = 5.74, 21.97).

Conclusion: The offer of, and instructions to use, reduced nicotine content cigarettes during an 8-week period led to greater use of alternative tobacco/nicotine products compared with continued use of normal nicotine cigarettes and also reductions in smoking rates.

Keywords: Alternative nicotine delivery systems; electronic cigarettes; exposure biomarkers; medicinal nicotine; nicotine regulation; product standards; reduced nicotine content cigarettes; smokeless tobacco.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Biomarkers / urine
  • Cigarette Smoking / urine*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nicotine / analysis*
  • Nicotine / urine*
  • Tobacco Products / analysis
  • Tobacco Products / statistics & numerical data*
  • Tobacco Use Cessation Devices / statistics & numerical data*


  • Biomarkers
  • Nicotine