Low-nicotine cigarettes lead to less smoking in anxious and depressed smokers



Summary: Reducing nicotine levels to non-addictive levels reduces smoking without worsening symptoms of depression and anxiety for those with mental health disorders.

source: Pennsylvania state

Reducing the amount of nicotine in cigarettes to non-addictive levels may reduce smoking without worsening mental health in smokers with mood or anxiety disorders, according to Penn State Medical School and Harvard Medical School researchers.

They said that reducing the nicotine content in cigarettes can also reduce addiction, reduce exposure to toxic substances and increase a smoker’s chances of quitting.

Tobacco remains the leading preventable cause of premature death and disease in the United States. Recent proposals by the U.S. Food and Drug Administration and the New Zealand government seek to reduce the amount of nicotine in cigarettes to a minimum that is addictive.

Previous research suggests that reducing nicotine content can help smokers quit, but there is little evidence to prove whether these policies can negatively affect smokers with current or pre-existing emotional disorders such as depression and anxiety disorders – which affect their health. An estimated 38% of cigarette smokers in the United States.

According to Jonathan Foulds, professor of public health sciences, psychiatry, and behavioral health, smokers with mental health conditions are more likely to have severe nicotine withdrawal symptoms and less success in quitting smoking.

He also said there is speculation that reducing nicotine content to very low levels could exacerbate psychological symptoms in smokers with mental health conditions and lead to increased smoking and increased exposure to toxic substances or harmful chemicals.

The researchers studied 188 smokers who had a history of or had a current mood or anxiety disorder and had no plans to quit smoking.

Volunteer participants were randomly assigned to a group that received either research cigarettes containing the usual amount of nicotine (11.6 mg nicotine/cigarette) or a gradually reduced amount of nicotine for an additional 18 weeks (final amount was 0.2 mg nicotine/cigarette).

At the beginning and conclusion of the study, researchers measured levels of cotinine, a nicotine metabolite, levels of harmful chemicals, indices of cigarette dependence and various mental health measures.

The researchers noted that there were no statistically significant differences in measures of mental health between the two groups at the conclusion of the study.

The team used the Kessler Psychological Disorder Scale, a six-item self-report assessment in which participants reported on a 5-point scale the degree to which they felt feelings or emotions such as “nervous,” “hopeless,” or “so depressed that nothing could cheer them up.” for them.” The results are developed by collecting points for the six trials.

Participants in the low nicotine content group scored an average of 5.3 at the start of the study and finished with an average score of 4.6, while those in the usual nicotine content group scored 6.1 at the start of the study and finished around 4.9.

“These findings are important because we want to understand the impact of these policies on smokers with anxiety or depressive disorders,” said Foulds, a researcher at the Penn State Cancer Institute.

“Our data showed that there was no significant difference in mental health measures between groups, suggesting that lower nicotine cigarettes may not have adverse psychological effects in this population.”

Similar to what has been reported by previous studies, Foulds and the team found that groups in the lower nicotine content group absorbed less nicotine and ingested lower levels of harmful carcinogens such as the biomarker 4-(methylnitrosamino]-1-(3-pyridyl)-1. butanol), more commonly known as NNAL. This group also smoked fewer cigarettes and reported lower levels of nicotine addiction by the end of the randomized phase of the trial.

The results were published in PLOS ONE today, November 2.

Uniquely in this study, participants in both groups were also given the option to ‘choose treatment’ after an 18-week period. They can go back to using their cigarettes, continue to smoke search cigarettes or try to quit.

Among the 188 study participants, those randomized to cigarettes with low nicotine content were more likely to quit after 12 weeks (18.1%), compared to the control group (habitual nicotine content) (4.3%).

Tobacco remains the leading preventable cause of premature death and disease in the United States. The image is in the public domain

“We believe this is the first randomized trial to find that smokers who used low-nicotine cigarettes were more likely to quit (with biochemical validation), three months after the trial ended,” Foulds said.

“Our results suggest that these policies will likely result in reduced nicotine absorption from cigarettes without worsening the mental health of smokers with mood or anxiety disorders,” said Dr. Aiden Evins, professor of psychiatry at Harvard Medical School. “They also suggest that with appropriate support and resources, smokers with mood and anxiety disorders can successfully quit smoking as a result of these policies.”

For more information about nicotine, smoking, and health studies at the Penn State Center for Tobacco and Health Research, visit https://research.med.psu.edu/smoking/#participants.

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Susan Feldher, Ahmed Hamid, Sophia Allen, Jessica Youngst, Erin Hammett, Jennifer Modesto, Nicole Krebs, Courtney Lester, Neil Truschen, Lisa Reinhart, Emily Wasserman, Jonja Chu, Jason Liao, Joshua Muscat and John Ritchie of Penn State Medical School; Shari Hrabowski of Penn State Ross and Carol Ness College of Nursing; And contributed to this research, Gladys Pasha, Corinne Cather, Nour Azzouz and A. Eden Evins of Harvard Medical School. Foulds and Ivins provide paid consulting to pharmaceutical companies involved in producing smoking-cessation drugs. The other author’s conflict of interest is indicated in the manuscript.

Financing: This research was supported by the National Institutes of Health through the National Institute on Drug Abuse of the National Institutes of Health (award P50DA036107) and the National Center for the Advancement of Translational Science through the Penn State Clinical and Translational Science Institute (award UL1 TR000127). The research was also supported by the US Food and Drug Administration’s Center for Tobacco Products. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

About this nicotine addiction and mental health research news

author: Sarah Lagounis
source: Pennsylvania state
Contact: Sarah Lagounis – Pennsylvania
picture: The image is in the public domain

original search: open access.
Effects of cigarettes with low nicotine content on nicotine biomarkers and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: a randomized double-blind trial.By Jonathan Foulds et al. PLUS ONE


Effects of cigarettes with low nicotine content on nicotine biomarkers and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: a randomized double-blind trial.


The US Food and Drug Administration and the New Zealand government have suggested reducing the nicotine content in cigarettes to very low levels. This study examined the potential effects of this regulation on smokers with emotional disorders.


In a randomized, parallel group controlled trial conducted at two US sites (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with current (n = 118) or lifelong (n = 70) anxiety or disorder Unipolar moods, not planning to quit in the next six months, were randomly assigned (1:1) to smoke either usual nicotine content (UNC) (11.6 mg nicotine/cigarettes) in search of cigarettes, or search for low nicotine content ( RNC) cigarettes in which the nicotine content per cigarette gradually decreases to 0.2 mg in five steps over 18 weeks. Participants were then offered a choice between receiving help to quit smoking, receiving free research cigarettes, or resuming use of their cigarette brand during a 12-week follow-up period. The main outcomes were biomarkers of exposure to nicotine and toxicants, smoking and dependence behavior and severity of psychiatric symptoms. The primary pre-recorded outcome was plasma cotinine.


A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to cigarettes with lower nicotine content, compared to smokers in the UNC group, at the last randomized visit, the RNC group had significantly lower plasma cotinine (a metabolite of nicotine): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urinary NNAL (NNK metabolite, lung carcinogen), exhaled carbon monoxide, cigarette consumption, and cigarette dependence were significantly lower in the RNC group than in the UNC group. No differences were found between groups in a range of other biomarkers (eg 8-isoprostanes) or health indicators (eg blood pressure), or in 5 different psychiatric questionnaires, including the Kessler K6 Psychological Distress Scale. At the end of the 12-week post-treatment selection phase, those randomized to the RNC group were more likely to quit, based on the initial intent-to-treat sample, n = 188 (18.1% RNC v 4.3% UNC, p = 0.004).


Reducing nicotine content in cigarettes to very low levels reduces exposure to certain toxicants and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without deteriorating mental health.

Demo registration

TRN: NCT01928758registered on August 21, 2013.

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