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The US Food and Drug Administration (FDA) has invested tens of millions of dollars in clinical trials examining the effectiveness of very low nicotine cigarettes for smoking cessation among smokers, including vulnerable populations, with promising results.1 Trials indicate that very low nicotine cigarettes reduce dependence and increase quit attempts in comparison with standard nicotine cigarettes.2–8 Subsequently, in 2017, the FDA announced a new, nicotine-centred framework for tobacco regulation that includes greatly reducing the nicotine in combustible cigarettes and encouraging innovation in safer forms of nicotine.9 Then, in 2018, the FDA released an advanced notice of proposed rulemaking on cigarette nicotine reduction.10 The aim is to reduce nicotine to minimally addictive or non-addictive levels in order to reduce smoking initiation and aid smoking cessation.11 The tobacco control community is cautiously optimistic that a nicotine reduction policy may be the big step needed to make substantial progress in reducing tobacco-caused death and disease in the USA.12–14 Other countries are considering similar measures.15 16 …
Contributors MJB and CDD conceived of this commentary and drafted the initial text, and all authors contributed to the research, writing and final editing.
Competing interests The authors have received grant funding from the National Cancer Institute and the Food and Drug Administration Center for Tobacco Products.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This commentary does not involve data analysis.