One of the biggest objections to lowering the nicotine in cigarettes has been a simple assumption that smokers would just smoke more to make up for the missing nicotine. But a new study suggests the fear is largely unfounded.

Researchers at Wake Forest University School of Medicine found that people who switched to cigarettes containing dramatically less nicotine generally did not compensate by smoking more cigarettes or inhaling more deeply. In fact, most ended up smoking fewer cigarettes each day.

The “light” cigarettes of decades ago used ventilated filters rather than reducing nicotine, so many smokers compensated by taking deeper puffs or smoking more cigarettes. Today's low-nicotine smokes are different.

The findings could have important implications for a proposed U.S. Food and Drug Administration (FDA) rule that would require cigarettes and certain other combustible tobacco products to contain only minimally addictive levels of nicotine.

To better understand how smokers respond to cigarettes with very low nicotine levels, researchers led by Rachel Denlinger-Apte, an assistant professor of social sciences and health policy at Wake Forest, conducted a systematic review of 17 randomized clinical trials published between 2010 and 2024. Together, the studies included more than 5,500 adolescents and adults who smoked cigarettes.

Participants were randomly assigned to smoke either conventional cigarettes or cigarettes containing about 95 percent less nicotine. Researchers then tracked whether smokers changed their behavior by smoking more cigarettes each day or inhaling more deeply, increasing their exposure to harmful smoke.

That concern stems from the disappointing history of so-called “light” cigarettes. Decades ago, tobacco companies marketed these products as a healthier alternative, but the early versions of light cigarettes used ventilated filters rather than actually reducing nicotine, so many smokers compensated by taking deeper puffs or smoking more cigarettes, exposing themselves to just as many toxic chemicals.

Today's very low nicotine cigarettes are different. Rather than relying on filter design, they contain far less nicotine, the chemical responsible for addiction, than the light cigarettes of decades past.

The study found little evidence that smokers tried to make up for the lower nicotine content by smoking more. None of the 17 clinical trials reported an increase in the average number of cigarettes smoked each day among participants assigned to the very low nicotine cigarettes. In fact, 16 of the 17 studies found that participants smoking the low-nicotine cigarettes actually reduced the number of cigarettes they smoked daily.

The researchers also found no evidence that participants increased their exposure to carbon monoxide, an indicator that they were inhaling more smoke. After six weeks of using the low-nicotine cigarettes, fewer than one percent of participants were predicted to smoke more than they had before switching. Some smokers even made spontaneous attempts to quit altogether.

Sixteen of the 17 studies found that participants smoking the low-nicotine cigarettes actually reduced the number of cigarettes they smoked daily.

“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 press release. “The prevalence is down, but the numbers are still high, and tobacco is still one of the leading causes of premature and preventable death.”

The study's data provide important scientific support for the FDA's proposed nicotine product standard, which remains under review. By reducing nicotine to minimally addictive levels, public health experts hope fewer young people will become addicted to cigarettes, while making it easier for current smokers to quit.

If the proposed federal regulations move forward, the study suggests that lowering nicotine levels may help reduce cigarette consumption without causing smokers to inhale more harmful smoke. It's a result that may translate into meaningful public health benefits for millions of Americans.

The study is published in JAMA Network Open.