How a nicotine reduction policy could reduce smoking disparities and boost productivity
Computer modeling by Rutgers researchers shows a federal standard could drive U.S. smoking rates below 1% in 14 years
Rutgers University
Implementing a federal nicotine reduction strategy may prevent millions of premature deaths, boost productivity, and significantly close smoking disparity gaps for individuals with major depression, according to Rutgers Health researchers.
Their study, published in the journal Tobacco Control, evaluated the potential impact of the Food and Drug Administration’s proposed product standard to cap nicotine in combusted tobacco products at minimally or nonaddictive levels. Cigarettes are harmful to health, but nicotine is the primary addictive agent that gets people hooked on smoking and makes it hard to quit. A cigarette on average has 10 to 14 milligrams of nicotine. The FDA proposed capping it at 0.7 milligrams.
Using a simulation model – a computer forecasting method – researchers at the Rutgers Institute for Nicotine and Tobacco Studies and the Rutgers School of Public Health modeled long-term health and financial impacts on the U.S. population through 2100. The study focused on how this policy could affect individuals living with major depression, a vulnerable group that smokes at disproportionately higher rates than the general public.
“Tobacco use heavily impacts vulnerable groups,” said Sarah Skolnick, a postdoctoral associate at the Rutgers Institute for Nicotine and Tobacco Studies. “The model shows that a nicotine reduction policy would directly reduce tobacco-related health disparities, specifically protecting individuals suffering from major depression. We were particularly interested in this impact on the population with major depression, because we know that depression can increase smoking, and smoking can, in turn, increase depression.”
The study enabled researchers to represent a complex system, capturing current population dynamics and testing various scenarios.
“The simulation begins with individuals born without major depression or any smoking experience,” explained Jamie Tam, an associate professor at Rutgers School of Public Health and the institute. “Then as the simulation progresses, it tracks how people transition into various health states, such as taking up smoking, starting to vape, doing both, or developing depression.”
The findings were scaled to represent health and economic costs for the United States population, using data from the Medical Expenditure Panel Survey and the National Survey on Drug Use and Health.
The researchers found that implementing this policy could drive smoking rates below 1% for all population groups by the year 2040, nearly eliminating smoking for people both with and without major depression. By reducing tobacco use, the model projected that the policy could prevent 1.6 million premature deaths and 8 million people from developing major depression by 2100.
Under the policy, the model also projected that worker productivity could increase by $298 billion and the economy could realize a $1.3 trillion increase in consumer spending. “When people die early because of smoking, we lose their contributions to society as consumers and as members of the working population,” Tam adds. “Reducing smoking through nicotine reduction would help people live longer, healthier lives, and allow them to continue contributing to our economy.”
While a federal mandate on nicotine levels remains uncertain, the researchers said state and local governments have the power to act now through sales restrictions, similar to flavor restrictions.
“Individual states do not have to wait,” Skolnick said. “They can independently implement nicotine reduction policies today to protect their residents.”
The results from this study can be explored through the Tobacco Control Policy Tool, an online interactive interface developed by the study team.”
Funding for this study was provided by the National Institutes of Health (NIH)’s National Institute on Drug Abuse, under award number K01DA056424. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Computer modeling by Rutgers researchers shows a federal standard could drive U.S. smoking rates below 1% in 14 years
Rutgers University
Implementing a federal nicotine reduction strategy may prevent millions of premature deaths, boost productivity, and significantly close smoking disparity gaps for individuals with major depression, according to Rutgers Health researchers.
Their study, published in the journal Tobacco Control, evaluated the potential impact of the Food and Drug Administration’s proposed product standard to cap nicotine in combusted tobacco products at minimally or nonaddictive levels. Cigarettes are harmful to health, but nicotine is the primary addictive agent that gets people hooked on smoking and makes it hard to quit. A cigarette on average has 10 to 14 milligrams of nicotine. The FDA proposed capping it at 0.7 milligrams.
Using a simulation model – a computer forecasting method – researchers at the Rutgers Institute for Nicotine and Tobacco Studies and the Rutgers School of Public Health modeled long-term health and financial impacts on the U.S. population through 2100. The study focused on how this policy could affect individuals living with major depression, a vulnerable group that smokes at disproportionately higher rates than the general public.
“Tobacco use heavily impacts vulnerable groups,” said Sarah Skolnick, a postdoctoral associate at the Rutgers Institute for Nicotine and Tobacco Studies. “The model shows that a nicotine reduction policy would directly reduce tobacco-related health disparities, specifically protecting individuals suffering from major depression. We were particularly interested in this impact on the population with major depression, because we know that depression can increase smoking, and smoking can, in turn, increase depression.”
The study enabled researchers to represent a complex system, capturing current population dynamics and testing various scenarios.
“The simulation begins with individuals born without major depression or any smoking experience,” explained Jamie Tam, an associate professor at Rutgers School of Public Health and the institute. “Then as the simulation progresses, it tracks how people transition into various health states, such as taking up smoking, starting to vape, doing both, or developing depression.”
The findings were scaled to represent health and economic costs for the United States population, using data from the Medical Expenditure Panel Survey and the National Survey on Drug Use and Health.
The researchers found that implementing this policy could drive smoking rates below 1% for all population groups by the year 2040, nearly eliminating smoking for people both with and without major depression. By reducing tobacco use, the model projected that the policy could prevent 1.6 million premature deaths and 8 million people from developing major depression by 2100.
Under the policy, the model also projected that worker productivity could increase by $298 billion and the economy could realize a $1.3 trillion increase in consumer spending. “When people die early because of smoking, we lose their contributions to society as consumers and as members of the working population,” Tam adds. “Reducing smoking through nicotine reduction would help people live longer, healthier lives, and allow them to continue contributing to our economy.”
While a federal mandate on nicotine levels remains uncertain, the researchers said state and local governments have the power to act now through sales restrictions, similar to flavor restrictions.
“Individual states do not have to wait,” Skolnick said. “They can independently implement nicotine reduction policies today to protect their residents.”
The results from this study can be explored through the Tobacco Control Policy Tool, an online interactive interface developed by the study team.”
Funding for this study was provided by the National Institutes of Health (NIH)’s National Institute on Drug Abuse, under award number K01DA056424. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Journal
Tobacco Control
Tobacco Control
DOI
Method of Research
Computational simulation/modeling
Computational simulation/modeling
Subject of Research
People
People
Article Publication Date
15-Jul-2026
15-Jul-2026
Less nicotine, fewer cigarettes: New study finds smokers are unlikely to smoke more when switching to low-nicotine cigarettes
Wake Forest University School of Medicine researchers analyzed 17 clinical trials and found little evidence that smokers compensate for less nicotine by smoking more cigarettes or inhaling more deeply, debunking long-held myths
WINSTON-SALEM, N.C., July 15, 2026 — People who switch to cigarettes with dramatically reduced nicotine levels are unlikely to smoke more cigarettes or inhale more smoke to compensate for the lower nicotine content, according to a new study led by researchers at Wake Forest University School of Medicine and published in JAMA Network Open.
The systematic review examined 17 randomized clinical trials involving more than 5,500 adolescents and adults. Researchers found little evidence that smokers compensated for reduced nicotine by increasing their smoking behavior. In fact, researchers found most of the study participants smoked fewer cigarettes after switching to low nicotine. The findings are relevant to a proposed U.S. Food and Drug Administration product standard that would reduce nicotine levels in cigarettes and certain other combusted tobacco products to minimally or nonaddictive levels. The proposed rule remains under FDA review.
“Cigarette smoking is at a historic low, a public health victory, but that’s still 25 million people who smoke,” said lead author Rachel Denlinger-Apte, Ph.D., M.P.H., assistant professor of social sciences and health policy at Wake Forest University School of Medicine.
Data from the Centers for Disease Control and Prevention shows more than 40% of adults in the U.S. smoked in the mid-1960s. That number has dwindled to just under 10% in recent years.
“The prevalence is down, but the numbers are still high, and tobacco is still one of the leading causes of premature and preventable death,” she added.
Public health efforts to further reduce smoking have recently included “very low nicotine content” cigarettes, which contain about 95% less nicotine than conventional cigarettes. Because nicotine is the addictive chemical in cigarettes, lowering nicotine levels could help prevent future generations from becoming dependent on tobacco and support people trying to quit by easing withdrawal symptoms, according to researchers.
However, confusion between low-nicotine cigarettes and so-called “light” cigarettes has fueled concerns.
Unlike low-nicotine cigarettes, “light” cigarettes are not low in nicotine and rely on ventilated filters to dilute inhaled smoke. Developed decades ago, amid growing awareness of tobacco’s health risks, “light” cigarettes resulted in a behavior known as “compensatory smoking,” whereby smokers smoke more or inhale more deeply.
The concern is that lower-nicotine products – if similar to “light” cigarettes – might lead to the same compensatory smoking behavior, ultimately increasing exposing to harmful ingredients over time.
The research shows the opposite.
“Our findings suggest that widespread compensatory smoking is unlikely to occur if a low-nicotine product standard is implemented,” Denlinger-Apte said. “The concern has been that people would smoke more cigarettes or inhale more deeply to get the nicotine they are used to receiving. Across 17 clinical trials, we found minimal evidence that this happens.”
In the systematic review, Denlinger-Apte and colleagues examined clinical trials published between 2010 and 2024 and also performed an analysis using data from more than 2,400 smokers enrolled in seven U.S. studies. They found that none of these trials reported increases in the number of average cigarettes smoked per day among people assigned to the very low nicotine cigarettes. Sixteen of the 17 trials also found participants smoking low nicotine cigarettes actually smoked fewer cigarettes per day than those smoking traditional cigarettes. Many even made spontaneous attempts to quit, Denlinger-Apte said.
Additional findings showed no evidence of reported increases in average carbon monoxide exposure. After six weeks, fewer than 1% of participants were predicted to smoke more.
Denlinger-Apte said evidence like the recent analysis could bolster the chances of proposed FDA policies and ultimately lead to fewer smokers.
“While smoking rates are down, the toll of tobacco use remains substantial, and there is still an urgent need for policies that help prevent nicotine addiction and support people who want to quit,” she said. “Modeling studies have suggested that a nationwide nicotine product standard could substantially reduce smoking over time, including by prompting millions of people to quit.
“It could be one of the most impactful public health policies of this century,” she said.
This research was supported by the National Institutes of Drug Abuse and the FDA’s Center for Tobacco Products grants U54DA031659, U54DA036114, R01DA058264, R01DA046320, K01CA189300 and K01MD014795.
Journal
JAMA Network Open
Method of Research
Meta-analysis
Subject of Research
People
Article Title
Compensatory Smoking With Very Low Nicotine Content Cigarettes
Article Publication Date
15-Jul-2026
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