Compensatory Smoking With Very Low Nicotine Content Cigarettes

If the US Food and Drug Administration (FDA) implements a low-nicotine product standard for cigarettes, will people who smoke increase their smoking behavior or smoke exposure?In this systematic review and meta-analysis of 17 trials with 5500 adolescent and adult participants, no trials in the systematic review reported increases in the number of cigarettes smoked per day or exhaled breath carbon monoxide (CO) exposure among participants assigned to very low nicotine content cigarettes (VLNCs). In the meta-analysis, fewer than 1% of the participant population could be expected to increase cigarettes smoked per day, and 8% could be expected to increase CO exposure when smoking VLNCs.This study suggests that an FDA-mandated low-nicotine product standard for cigarettes is unlikely to result in widespread compensatory smoking.

Corresponding Author: Rachel L. Denlinger-Apte, PhD, MPH, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (rachel.denlinger@wfusm.edu).

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