Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States

Apelberg, Benjamin J.; Feirman, Shari P.; Salazar, Esther; Corey, Catherine; Ambrose, Bridget K.; Paredes, Antonio; Richman, Elise; Verzi, Stephen Joseph; Vugrin, Eric D.; Brodsky, Nancy S.; Rostron, Brian L.

doi:10.1056/nejmsr1714617

Cited by 143 publications

(111 citation statements)

References 30 publications

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“…Another goal was to provide empirical data regarding potential acute effects of reducing nicotine content in cigarettes, as the US Food and Drug Administration is considering policy to set a maximum level of nicotine content in cigarettes to render them minimally addictive . A simulation model with inputs derived from empirical evidence has predicted that reducing the nicotine yield of cigarettes to 0.4 mg would reduce the number of smokers in the United States by approximately 13 million within 5 years …”

Section: Introductionmentioning

confidence: 99%

Neural basis of smoking‐induced relief of craving and negative affect: Contribution of nicotine

et al. 2018

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Smoking-induced relief of craving and withdrawal promotes continued cigarette use.Understanding how relief is produced and the role of nicotine in this process may facilitate development of new smoking-cessation therapies. As the US Food and Drug Administration considers setting a standard for reduced nicotine content in cigarettes to improve public health, knowledge of how nicotine contributes to relief also can inform policy. We assessed effects of nicotine using resting state functional magnetic resonance imaging (MRI) and behavioral assessments of craving and negative affect.Twenty-one young (18-25 years old) daily smokers underwent overnight abstinence on 4 days. On each of the following mornings, they self-rated their cigarette craving and negative affect and underwent resting-state functional MRI (fMRI) before and after smoking a cigarette that delivered 0.027, 0.110, 0.231, or 0.763 mg of nicotine. Functional connectivity between the anterior insula and anterior cingulate cortex (ACC) and between the nucleus accumbens and orbitofrontal cortex (OFC) was assessed. Smoking reduced craving, negative affect, and nucleus accumbens-OFC connectivity irrespective of nicotine dose, with positive correlations of the effects on behavioral and connectivity measures. Only the highest nicotine dose (0.763 mg) reduced right anterior insula-ACC connectivity; this reduction was positively correlated with the behavioral effects of the 0.763-mg dose only. While nicotine-based therapies may act on right anterior insula-ACC functional circuits to facilitate smoking cessation, non-nicotine (eg, the conditioned and sensorimotor) aspects of smoking may promote cessation by reducing OFC-accumbens connectivity to alleviate withdrawal.

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Section: Introductionmentioning

confidence: 99%

Neural basis of smoking‐induced relief of craving and negative affect: Contribution of nicotine

et al. 2018

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“…An estimated 8.5 million tobacco-related deaths in the United States could be averted by 2100 if this regulation were implemented. 5 …”

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confidence: 99%

Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke Exposure

Hatsukami

Luo

Jensen

et al. 2018

JAMA

135

201

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“…In July 2017, the U.S. Food and Drug Administration (FDA) announced a plan for a new tobacco regulation strategy that lowers nicotine in cigarettes to minimally or nonaddictive levels [1]. This groundbreaking policy has not been tried anywhere in the world yet and may have significant positive public health impacts [2]. However, to increase the success of this regulation, it should be implemented with education about nicotine.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes

Yang

Owusu

Popova

2019

IJERPH

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We examined how a nicotine fact sheet influenced smokers’ beliefs about nicotine and electronic cigarettes (e-cigarettes), a potentially less harmful alternative to conventional cigarettes. In an exploratory online experiment, 756 US adult current and recent former smokers (quit in the past 2 years) were randomized to view a nicotine fact sheet or control messages (bottled water ads). Effects of the nicotine fact sheet on perceived nicotine addictiveness, nicotine risk, comparative risk of e-cigarettes, and dual use intentions were analyzed using log-Poisson regression with robust error. Linear regression analyzed effects on perceived absolute risk and switching and information seeking intentions about e-cigarettes. Compared to control, the nicotine fact sheet doubled the probability of disagreeing that nicotine is the main cause of smoking-related disease (26.2% vs. 12.7%, RR = 2.06, 95% CI = 1.51, 2.82, p < 0.001). However, nearly three quarters of participants viewing the nicotine fact sheet still thought that nicotine is the main cause of smoking-related disease. The nicotine fact sheet increased smokers’ intentions to seek information about e-cigarettes (b = 0.45, 95% CI = 0.15, 0.74, p = 0.003). We did not find evidence suggesting unintended consequences of the nicotine fact sheet on smokers’ e-cigarettes risk perceptions or use intentions (e.g., increased dual use intentions or reduced absolute e-cigarette risk perception).

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Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States

Cited by 143 publications

References 30 publications

Neural basis of smoking‐induced relief of craving and negative affect: Contribution of nicotine

Neural basis of smoking‐induced relief of craving and negative affect: Contribution of nicotine

Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke Exposure

Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes

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