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Nicotine Addiction

E-cigarettes and smoking cessation in real-world and clinical settings

http://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(15)00521-4.pdf

Summary

Background

Smokers increasingly use e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited. We aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes.

Methods

PubMed and Web of Science were searched between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed using a random effects meta-analysis. A modification of the ACROBAT-NRSI tool and the Cochrane Risk of Bias Tool were used to assess bias. This meta-analysis is registered with PROSPERO (number CRD42015020382).

Findings

38 studies (of 577 studies identified) were included in the systematic review; all 20 studies with control groups (15 cohort studies, three cross-sectional studies, and two clinical trials) were included in random effects meta-analysis and sensitivity analyses. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes (odds ratio [OR] 0·72, 95% CI 0·57–0·91). Association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes (irrespective of interest in quitting cigarettes) compared with studies of only smokers interested in cigarette cessation (OR 0·63, 95% CI 0·45–0·86 vs 0·86, 0·60–1·23; p=0·94). Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of abstinence, and definition of e-cigarette use) were also not associated with the overall effect size (p≥0·77 in all cases).

Interpretation

As currently being used, e-cigarettes are associated with significantly less quitting among smokers.

Funding

National Institutes of Health, National Cancer Institute, FDA Center for Tobacco Products.

E-cigarette Ads and Youth

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Regulators urged to scrutinise e-cigarettes

http://www.herald.co.zw/regulators-urged-to-scrutinise-e-cigarettes/

Harvard researchers recently examined 51 separate liquid vaping flavours, and their findings are downright frightening. It may not be the most highly publicised “war,” but the US government and the Centres for Disease Control and Prevention have been waging war against tobacco for more than five decades. The results have been nothing short of impressive, with campaigns to educate the public about the dangers of tobacco use leading the adult tobacco use rate in the US to drop from 42 percent in the mid-1960s to 18 percent as of 2013.

The push-back against the US tobacco industry has threatened the growth prospects for giants like Altria, with its signature Marlboro brand, and Reynolds American, maker of Newport. These tobacco product giants have relied on their incredible pricing power and the addictive nature of nicotine to keep their bottom lines strong. Between 2008 and 2013, overall consumer prices rose by a tame 8,2 percent, according to the US Department of labour. Meanwhile, cigarette prices rose an astounding 50percent in that same time frame – more than any other product measured.

The other growth avenue for the tobacco industry is tobacco alternatives, a niche dominated by electronic cigarettes. An electronic cigarette works by heating a flavoured liquid containing nicotine into a vapour, which the user then inhales. This allows users to satiate their nicotine craving while consuming less of the harmful chemicals often found in smoked tobacco. But there have been questions surrounding the safety of electronic cigarettes since day one.

To begin with, regulators are worried that the tobacco industry could be catering to a new, and young, generation of nicotine addicts with flavours like bubble gum and cotton candy. Altria and Reynolds American have been clear that this is not their intention, but it clearly has regulators worried.

Further, the nicotine-containing liquids come in thousands of flavours, and not a single one is governed by the Food and Drug Administration.

Some view this as a good thing for the electronic-cigarette industry, because it means there are few barriers to expansion. Then again, a lack of regulation has left some wondering what’s actually in these solutions beyond nicotine and whether the solution is safe to inhale over the long run.

A recent study conducted by researchers at Harvard T.H. Chan School of Public Health offered an insight into the composition of the flavoured liquids – and let’s just say that electronic-cigarette users won’t be happy about the findings.

The study, which was published in the online journal Environment Health Perspectives, analysed a sample of 51 electronic-cigarette liquids for the presence of three flavouring chemicals – diacetyl, 2,3-pentanedione, and acetoin – all of which are known to have adverse effects on users’ lungs. Researchers attached each electronic cigarette to a lab-built and sealed device that drew air through the e-cig for eight seconds, with a break of between 15 and 30 seconds between each draw. Researchers then analysed the air stream for the aforementioned three flavouring chemicals.

The findings showed that 47 of 51 liquids tested (92 percent) contained at least one of the three chemicals. Specifically, 39 of 51 (76 percent) contained an above-laboratory-limit amount of diacetyl, a chemical known to cause bronchiolitis obliterans, also known as popcorn lung, and other respiratory diseases in users. Popcorn lung, which is named after workers who developed the disease after working in popcorn factories and inhaling diacetyl, causes inflammation and scarring of the air sacs of the lungs. It can ultimately result in the need for a lung transplant.

What’s notable is that the researchers’ findings on diacetyl occurred in flavours such as cotton candy, cupcake, and fruit squirts – in other words, flavours that would likely appeal to younger people. That’s concerning, given that there are no regulations covering the industry. As Taylor Hays, director of Mayo Clinic Nicotine Dependence Centre, told USA Today: “There are no FDA regulations on these products. It’s the Wild West of e-cigarettes.”

It should be noted that researchers from Harvard can’t conclusively link the chemicals found in the vapour tested with popcorn lung or any number of other diseases in electronic-cigarette users. However, the correlation is certainly worrisome and worthy of additional follow-up.

If the study from Harvard demonstrates anything, it’s that the FDA has an ever-growing reason to get involved in the regulation of the electronic-cigarette industry. The FDA has been weighing whether or not to classify electronic cigarettes as a tobacco product for some time now. Doing so would allow it to regulate the industry, including the chemical composition of the vaping liquid produced.

This isn’t to say that liquid vaping producers would need to change anything so much as they would need to disclose any known harmful chemicals on their packaging.

Additionally, the FDA would work hard to ensure that there’s consistency in the chemical composition of the liquids produced from one batch to the next.

However, if the FDA gets involved you can almost count on slower growth for the industry.

Each new flavour would need to go through extensive testing to be approved for retail sale. Further, increased levels of transparency and the use of potentially harmful components in vaping liquid and/or the vaping process could harm sales. — Reuters.

Cancer risk for smokeless tobacco users

http://www.medicalnewstoday.com/articles/302744.php

Adults in the US who use only smokeless tobacco products have higher levels of biomarkers of exposure to nicotine and NKK – a cancer-causing toxicant – compared with those using only cigarettes, according to research published in Cancer Epidemiology, Biomarkers & Prevention.

Use of smokeless tobacco products is attracting increasing attention from the public health community. Though smokeless tobacco use is less common than cigarettes, it is prevalent among certain population groups, particularly men and young people.

The National Adult Tobacco Survey estimates that 7.1% of American men used chewing tobacco, snuff, dip, snus or dissolvable tobacco products in 2012-13.

Among US high school students, the National Youth Tobacco Survey (NYTS) found that 9.6% of males used chewing tobacco, snuff or dip and 2.7% used snus – a tobacco product that is put in the mouth – in 2013.

Since 2000, cigarette smoking prevalence has declined, but smokeless tobacco use among US youth has remained relatively consistent.

This is a cause for concern because it has been found to have several adverse health effects and has been identified as a cause of cancer.

Smokeless products known to contain carcinogens

Previous small studies have found high levels of toxic constituents, including carcinogens, in smokeless tobacco users, but more analysis of nationally representative data has been needed.

Lead author Brian Rostron, PhD, an epidemiologist in the Center for Tobacco Products at the US Food and Drug Administration (FDA), and colleagues examined data for 23,684 adult participants in the National Health and Nutrition and Examination Survey (NHANES) – a large, nationally representative study of US health behaviors and outcomes from 1999-2012.

They recorded participant-reported cigarette and smokeless tobacco use and categorized individuals into four groups: 16,313 non-tobacco users, 488 exclusive smokeless tobacco users, 6,791 exclusive cigarette smokers and 92 dual cigarette and smokeless tobacco users.

They analyzed biomarkers of exposure to seven tobacco constituents, including nicotine and tobacco-specific nitrosamine.

High levels of cotinine and NKK exposure in smokeless product use

The level of cotinine, the biomarker of nicotine exposure, was higher in exclusive smokeless tobacco users compared with exclusive cigarette smokers. The biomarker of NNK exposure was also higher in exclusive smokeless tobacco users compared with exclusive cigarette smokers.

The analysis confirms that levels of biomarkers of exposure to nicotine and the cancer-causing tobacco constituent NNK are higher among exclusive smokeless tobacco users than exclusive cigarette smokers. This continues to put smokeless tobacco users at risk for adverse health effects, including cancer.

Rostron says the findings confirm the need to continue studying of the toxic constituents of smokeless tobacco and their health effects on the individuals who use them.

The FDA and Centers for Disease Control and Prevention (CDC) are continuing to analyze and monitor biomarker levels among tobacco users.

In addition, the FDA and National Institutes of Health (NIH) are collaborating on the Population Assessment of Tobacco and Health (PATH) Study – a large longitudinal study that involves collection of biospecimens such as blood and urine.

Limitations of the current study include the nature of the data collected in NHANES. Being a general health survey, there is no detailed information on the type of smokeless tobacco product used, the quantity of smokeless tobacco product used and the duration or former use of smokeless tobacco products.

However, Rostron notes that the PATH Study data will allow for more specific analyses of tobacco use and harm.

The authors conclude:

“Our results have shown that smokeless tobacco users have high levels of known harmful and addictive constituents and that in some cases these levels are higher than those observed among cigarette smokers.

This finding is a cause of considerable concern for individual and public health. These results thus demonstrate the need for continuing study of the toxic constituents of smokeless tobacco as well as their health effects on the individuals who use them.”

Study Shows the Reason Why People Like to Smoke While Drinking

CTA SAYS: placing the onus on licensees to enforce the laws in their premises will prevent people smoking in bars as at present

TCO is way understaffed so it acts only on complaints, and days later, with no patrol capabilities

If nicotine addicts cannot go out and socialize in enforced NON SMOKING bars where the laws are actually legally enforced by the licensees, they will quit

http://www.foodworldnews.com/articles/49313/20151102/study-shows-reason-why-people-smoke-drinking.htm

Smoking while drinking? This is the most common scenario in bars and pubs. Despite the fact that the number of tobacco users already decreased, we can still count the number social smokers increasing especially for young men and women. The question is, what is it about drinking that changes the health conscious to become smokers overnight? According to Medical Daily, a recent study found that many drinkers want the stimulant effects of nicotine which helps them not to feel sleepy while drinking alcohol.

An estimated 90 percent of alcoholics also smoke tobacco this is according to the National Institute of Health. They said that even people who are not alcohol dependent are also known to smoke only when they start drinking. The connection between drinking and smoking has been acknowledged, scientists are still unsure what really makes them crave to start smoking.

To investigate the theory of what really makes people smoke when they are drinking, a team of researchers from the University of Missouri, gave rats fitted with sleep-recording electrodes nicotine and alcohol. After observing the effects of the two drugs on the rats’ brains, the team came to an interesting conclusion: Nicotine’s stimulant effect helps to ward off the sleepiness caused by alcohol consumption.

It affected the rat’s basal forebrain, it is the area of the brain associated with reflexes, learning and attention. On the other hand, alcohol which is a depressant inhibits the nervous system. Therefore, it is proven that it would help counteract the sleeping effects and increase alertness. In a past research it has been found that nicotine helps enhance the effects of alcohol. It actually adds to the “high” that alcohol gives and in turn increases the desire to drink more.

However, as we all know along with being two of the most widely used drugs, these are also some of the deadliest drugs. An average of about 6 million deaths each year is caused by smoking and about 3 million is because of excessive use of alcohol according to the World Health Organization

New CASAColumbia® Report Reveals Nicotine Is not A Harmless Drug

http://www.prnewswire.com/news-releases/new-casacolumbia-report-reveals-nicotine-is-not-a-harmless-drug-300163190.html

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NEW YORK, Oct. 22, 2015 /PRNewswire-USNewswire/ — A new report released today by CASAColumbia® reveals that alternative, non-combustible products that contain nicotine, but not tobacco, are not harmless, particularly for young people. Nicotine remains one of the most addictive and potent substances, regardless of whether it is delivered through a combustible cigarette, electronic cigarette, vape pen, hookah pipe or cigar.

The report, Understanding and Addressing Nicotine Addiction: A Science-Based Approach to Policy and Practice, demonstrates that electronic cigarettes and other nicotine products are increasingly being used by young people, many of whom have never smoked traditional cigarettes and who have expressed no interest in doing so. It also shows that there is no evidence of nicotine’s safety in young people, but there is evidence that its use is associated with an increased risk of other substance use and addiction.

“It is alarming that e-cigarette use has seen a three-fold increase over one year among middle and high school students,” said Samuel A. Ball, PhD, President and CEO of CASAColumbia. “This report highlights that these products are not safe for young people. E-cigarettes and other devices that contain nicotine promote dependence on one of the most addictive and easily available drugs. Exotic flavors can attract young people to vaping, and the added chemicals in the flavors may be harmful when inhaled.”

The authors of the report call upon policymakers to take action on nicotine product regulation and to fund more research on the health and safety of nicotine products. Although electronic cigarettes may be safer for those with nicotine addiction who have been unsuccessful in quitting cigarette smoking, these products have not been proven safe. Unlike FDA-approved nicotine replacement therapy, which is a safe and potentially effective smoking cessation method in adults, there is no strong evidence that electronic cigarettes and similar products are effective smoking cessation aids. There is some evidence that they might actually perpetuate cigarette smoking. Research shows that these products frequently are used in conjunction with cigarettes, rather than as a substitute for cigarettes, which increases the user’s exposure to nicotine.

“Our findings show that a science-based approach to the regulation of all nicotine-containing products is required,” said Linda Richter, PhD, Director of Policy Research and Analysis at CASAColumbia and the report’s lead author. “It’s time for the FDA, as well as state and local governments, to act to protect young people from the harms of nicotine and other addictive substances. That non-cigarette nicotine products are safer than cigarettes is not in dispute. But if we wait for all the evidence regarding their long-term harms and benefits to come in before we act, countless young people will get hooked on nicotine, a highly addictive drug.”

Highlights of the report include:

· Evidence regarding the prevalence of nicotine use and addiction
· The effects of nicotine on the brain and body
· Risk factors for nicotine addiction and the groups most at risk
· Current prevention and treatment efforts and the implications of this research for policymakers and health care providers
The report is available for download at no cost and can be found on our website at: http://www.casacolumbia.org/addiction-research/reports.

About CASAColumbia
CASAColumbia is a national nonprofit research and policy organization focused on improving the understanding, prevention and treatment of substance use and addiction. Founded in 1992 by former U.S. Secretary of Health, Education, and Welfare, Joseph A. Califano, Jr., our interdisciplinary experts collaborate with others to promote effective policies and practices. We conduct and synthesize research, inform and guide the public, evaluate and improve health care, and analyze and recommend policies on substance use and addiction. For more information, visit www.CASAColumbia.org.

Vaping might not help you quit

http://www.abc.net.au/triplej/hack/stories/s4336102.htm

South Australian researchers have found e-cigarettes aren’t helping people to quit smoking.

Their study is small, just 87 people were surveyed. Researchers pulled data from Quitline callers over eight months.

They said they thought vaping would help them deal with cravings, and replace the hand-to-mouth action of smoking. But it’s not working – most of those who vaped, vaped every day, and also had a nicotine addiction.

The organisation’s Lauren Maksimovic said some people thought e-cigarettes were too similar to smoking.

“They were using that hand to mouth action, but it actually enhanced their smoking and it was just the same thing, they were continuing to smoke”

She says people were also worried about the unknown impacts of vaping on their health.

“We maintain serious concerns about the safety of e-cigarettes, particularly given that it delivers chemicals directly to the lungs.”

There’s mixed opinions on vaping – a peak health body in England has said e-cigarettes are about 95 percent less harmful than tobacco cigarettes. But the Australian Cancer council has long campaigned against them, saying there’s no evidence e-cigarettes are safe or that they help with quitting attempts.

Under Victorian poisons laws, e-cigarettes are banned if they have nicotine in them. Many e-cigarettes don’t have nicotine – and the Cancer Council found some people were using them in conjunction with other pharmacotherapies to help them quit.

In NSW e-cigarettes can’t be sold to people under 18. Lauren Maksimovic says they’re currently being aggressively marketed to young people through advertising, and their fruit flavours.

“We really want to raise the awareness that there’s not evidence out there at the moment that e-cigarettes are useful in quitting.”

Nicotine Increases Codeine Relief, Could Mean Risk of Addiction

http://www.biosciencetechnology.com/news/2015/10/nicotine-increases-codeine-relief-could-mean-risk-addiction

Nicotine increases the amount of a specific enzyme in the brain that may increase the speed codeine is converted to morphine in the brain, according to research from the University of Toronto. The findings could implicate that smokers are at a higher risk for addiction to codeine.

Nicotine increases the amount of a specific enzyme in the brain that may increase the speed codeine is converted to morphine in the brain, according to research from the University of Toronto. The findings could implicate that smokers are at a higher risk for addiction to codeine.

Researchers, led by Rachel Tyndale, Ph.D., professor of pharmacology, toxicology, and psychiatry at the University of Toronto, administered codeine to rats in four groups and measured both their pain relief and levels of codeine and morphine.

The first group received nicotine for one week before receiving codeine; the second group was given an inhibitor, propranolol, which blocks the activation of codeine; the third group received both nicotine and the inhibitor, while a fourth control group was given neither.

The rats that received only nicotine had substantially more morphine in their brain and experienced greater pain relief, than those who also received the inhibitor. The group that was given propranolol and not nicotine had the lowest levels of pain relief and brain morphine. All of the groups maintained the same level of morphine in the blood, which showed it was change in the activity of the enzyme within the brain, not the liver that determined the effect of codeine on pain relief.

The biggest take away from the study, published earlier this year in Neuropsychopharmacology, “is there is genetic and environmental influences on the effects of drugs of abuse,” Tyndale, who is also senior scientists in the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health (CAMH), told Bioscience Technology. “In this case both those with faster activation of codeine to morphine, within the brain, due to genetics or due to induction of the enzyme, likely have better pain control, but also more risk for addiction to codeine. The latter group includes smokers. More generally it suggests that metabolism of drugs within the brain may alter the abuse potential for drugs.”

In the team’s preclinical mouse model, they showed that chronic nicotine increases the level of the enzyme in the brain which activates codeine to morphine. “We know this as we observe more of the enzyme in the brain in animals treated with nicotine, and in the brains of smokers in autopsy tissues,” Tyndale told Bioscience Technology. “When there is more of the enzyme in the brain, what we have shown is that codeine gets activated to nicotine more quickly and more extensively, increasing the pain relief from codeine by creating more morphine.”

This is a new way of looking at the brain’s role, as a more active participant, with codeine not just metabolized in the liver, but also in the brain itself.

“This is opening up a whole new area of research and potentially a substantial source of variation between people in their response to drugs and toxins acting on the brain,” Tyndale said. “We’re starting to see patterns and relationships, like the nicotine and codeine connection. This is also of interest in drug development as we might be able to create drugs that are only activated once they get to the brain.”

A limitation of the study is that it is a preclinical animal model. While the researchers know that the enzyme is higher in the brains of smokers, they still need to demonstrate that the brain enzyme is important to the effects of codeine in people.

Up next, the team plans to look at other opiates such as oxycodone, and hydrocodone, Tyndale said, “which are also metabolized by the same enzyme to determine what the effect of metabolism in the brain is for these other drugs.” They are also planning translational studies to take the work into humans.

LETTER: Smoke and mirrors

http://www.bdlive.co.za/opinion/letters/2015/10/16/letter-smoke-and-mirrors

DURING the Second World War, the Nazis murdered 10-million people. Those who resisted the Nazis were called partisans and freedom fighters. Tobacco products kill 6-million people per year.

Those who oppose this industry are labelled “nicotine nazis” by the manufacturers and its apologists. They have a perverted set of values.

In his latest column (Nicotine nazis hate one thing: pleasure, October 14), Leon Louw shows his warped understanding of addiction, tobacco control organisations and the history of the tobacco industry. He makes many false and weird assertions.

His rants against the National Council Against Smoking are baseless and do not merit a response.

His suggestion that the industry can help smokers find “freedom and dignity” is uninformed.

Since the 1960s, cigarette manufacturers have tried unsuccessfully to rally smokers to their cause by establishing and secretly funding “smoker’s rights groups”. They failed miserably because the overwhelming majority of smokers regret having started and wish to stop.

Most people smoke not because they want to but because they cannot easily stop. Addiction research shows that few people smoke for pleasure, and the main reason for continuing is to allay withdrawal symptoms.

Smokers crave nicotine not for pleasure, but to ward off irritation, anxiety, restlessness, depression, headaches, constipation and a host of other woes.

Moreover, far from seeing smokers as allies, the industry fears them. After decades of lying to its customers about the dangers of smoking, and manipulating nicotine levels to keep them addicted, the industry is now haunted by the spectre of litigation.

It has paid billions to those harmed by its products and is afraid it will have to pay much, much more.

Mr Louw preaches freedom but what he seeks is freedom to harm, not freedom from harm.

Dr Yussuf Saloojee

National Council Against Smoking

Low-nicotine cigarettes cut use, dependence, study finds; may aid push for FDA to set limits

http://www.usnews.com/news/business/articles/2015/09/30/low-nicotine-cigarettes-cut-use-dependence-study-finds

By MARILYNN MARCHIONE, AP Chief Medical Writer

A new study might help the push for regulations to limit nicotine in cigarettes. Smokers who switched to special low-nicotine ones wound up smoking less and were more likely to try to quit, researchers found.

The study only lasted six weeks, and researchers call the evidence preliminary. But they say it’s the first large study to show that slashing nicotine, perhaps below an addiction threshold, is safe and leads to less smoking.

The Food and Drug Administration was given the power in 2009 to mandate lower nicotine levels if it would help public health, but has not yet done so.

“This, I think, provides support” for lowering nicotine, said one study leader, Dr. Neal Benowitz of the University of California, San Francisco.

“What our study shows is that it’s feasible,” and that people won’t smoke more regular cigarettes to compensate, he said.

Results are in the New England Journal of Medicine. The FDA and the National Institute on Drug Abuse paid for the study. Two study leaders have advised companies that make smoking cessation aids, and two testified in tobacco lawsuits.

Smoking is a leading cause of heart disease and cancer. Tar and other substances inhaled through smoking make cigarettes deadly, but the nicotine in tobacco is what makes them addictive.

Some earlier work suggests they might not be if nicotine was limited to roughly 0.7 milligrams per gram of tobacco. Most cigarettes contain around 15.8 milligrams per gram of tobacco. There are no low-nicotine cigarettes on the market; the government made special ones with several lower nicotine levels to test.

“We wanted to see how much lower it would need to be to see that effect,” where dependence did not happen or was diminished, said another study leader, Dr. Eric Donny, a University of Pittsburgh psychologist.

For the study, about 800 people who smoked five or more cigarettes a day and had no interest in quitting were assigned to smoke either their usual brand or an experimental type with nicotine ranging from a low of 0.4 milligram to 15.8 milligrams, the level in most cigarettes.

The cigarettes were provided for free, and no one except people assigned to keep smoking their regular brand knew how much nicotine any of their smokes contained.

Smokers had to report daily how much they smoked and to make 10 office visits, some of which included tests to measure nicotine exposure and dependence. They were paid $20 an hour or so for the visits and extra for completing tests and daily calls, up to $835 in all.

The low-nicotine users were a little more likely to smoke some regular cigarettes in addition to the ones provided in the study, yet the overall number of cigarettes and nicotine levels were lower in those groups. During the last week of the study, those given cigarettes with low amounts of nicotine — 2.4, 1.3 or 0.4 milligrams per gram of tobacco — were averaging 15 or 16 smokes a day. That compares to 21 or 22 cigarettes for those given the 15.8-milligram cigarettes or their usual brand.

One low-nicotine level — 5.2 milligrams — did not cause any change in number of cigarettes smoked from smokers’ usual brand.

All low-nicotine cigarette users reported fewer symptoms of nicotine dependence on various standardized tests.

The study was not intended or designed to get smokers to quit. But twice as many in the low-nicotine group than those smoking standard-strength cigarettes — 35 percent versus 17 percent — said they had tried in the month after the study ended.

A longer study is under way to see whether a gradual or abrupt shift to low-nicotine cigarettes is best.

Dr. Michael Fiore and Timothy Baker, tobacco researchers from the University of Wisconsin, Madison, wrote in a commentary in the journal that the study shows the potential for a policy to cut nicotine that “could help to end the devastating health consequences” of smoking.
The FDA declined to comment on the study, but the director of its Center for Tobacco Products, Mitch Zeller, said in a statement that “though all tobacco products are potentially harmful and potentially addictive, different categories of tobacco products may have the potential for varying effects on public health.”

Two large cigarette makers — R.J. Reynolds Tobacco Co., which sells Camel and other brands, and Altria Group Inc., which owns Philip Morris USA — declined to comment.