Increase in Smoking Unlikely With Very Low Nicotine Cigarettes

THURSDAY, July 16, 2026 (HealthDay News) — For people assigned to smoking very low nicotine-content cigarettes (VLNCs), there is minimal evidence for compensation for reduced nicotine levels, according to a review published online July 15 in JAMA Network Open.

Rachel L. Denlinger-Apte, Ph.D., M.P.H., from the Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues examined whether people who smoke may increase their smoking to compensate for the reduced nicotine levels when smoking VLNCs for prolonged periods. Data were obtained from 17 randomized controlled trials published between 2010 and 2024, representing 5,500 adolescents and adults who smoked cigarettes daily or nondaily. A subset of 2,454 participants from seven trials were included in the pooled meta-analysis.

The researchers found that among those assigned to VLNCs or normal nicotine content cigarettes (NNCs), none of the trials reported increases in the mean number of cigarettes smoked or carbon monoxide (CO) exposure at the end of the intervention. At six weeks after randomization, an estimated 0.8 percent of participants could expect an increase in smoking, with a maximum expected increase of 3.3 cigarettes smoked/day; 8.1 percent could expect an increase in exposure to CO, with a maximum expected increase of 4.2 parts per million if assigned to VLNCs versus NNCs.

“Cigarette smoking is at a historic low, a public health victory, but that’s still 25 million people who smoke,” Denlinger-Apte said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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