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Voices & Opinion

POV: FDA’s Proposal to Cap Nicotine Levels in Cigarettes Would Benefit Public Health in Substantial Ways

Half a million smokers die prematurely every year. Reducing nicotine “could be the most impactful public health policy of the century”

My mom and dad both died prematurely from smoking-related chronic illnesses. They started smoking as teenagers, at a time when the health effects weren’t widely known, and despite knowing the harmful effects and wanting to quit smoking as adults, even after cancer diagnoses and relying on oxygen therapy to breathe, they were both unable to quit because nicotine is so addictive. If low-nicotine cigarettes had been the product standard, they could have lived longer. Each year, 480,000 Americans die from cigarette smoking. A low-nicotine product standard could save millions of lives.

The US Food and Drug Administration just proposed a mandated product standard that would cap—but not eliminate completely—the nicotine level in most combusted tobacco products, such as cigarettes, little filtered cigars, and cigarillos. These are the tobacco products that cause the most harmful effects from smoking. While nicotine is addictive, the combusted tobacco is what causes negative health effects, such as cancer, emphysema, and heart disease. Most people who smoke want to quit smoking, but only 5 percent to 9 percent of those who try to quit are successful. 

The FDA’s proposed product standard to reduce the nicotine level to nonaddictive levels would benefit public health in substantial ways. It would help those who want to quit smoking quit and would prevent young people from getting addicted to nicotine in the first place, transitioning to regular use and a lifelong addiction. Randomized clinical trials have consistently shown these outcomes. In fact, models suggest 13 million adults would quit smoking after one year of implementation, and by 2060, almost two million tobacco-related deaths would be prevented. Some concerns may be that low nicotine content products would lead to increased smoking or replacing with other substances. Fortunately, randomized clinical trial studies have demonstrated that low nicotine content cigarettes do not result in either of these outcomes.

This proposed policy includes other combusted tobacco products in addition to cigarettes, particularly cigarillos, little filtered cigars, and other large cigars. Some of my work has shown that people who smoke cigarillos or little filtered cigars incorrectly believe these products are less harmful than cigarettes. So, if a reduced nicotine standard were only implemented for cigarettes, people might shift to cigars, and their risk of tobacco-related harm would not change. Additionally, some people have incorrect beliefs about the relative harm of combusted vs. noncombusted tobacco/nicotine products. Older adults may also particularly benefit from limiting nicotine content. Our work has found that the rates of cigarette smoking among older adults have remained unchanged, compared to younger people, and they are more likely to incorrectly believe that noncombusted products, like e-cigarettes, are as harmful or more harmful than cigarettes. A low nicotine content product standard could help shift older adults who want to quit smoking towards lower harm alternatives. Importantly, a majority of people who smoke support this policy.

There will be challenges to implementing this product standard. The tobacco industry has a long history of manipulative tactics, including lying to the public, capitalizing on social movements, and putting out intentionally disruptive narratives that proliferate online and in news media. For example, in a coordinated effort with the tobacco industry, we have already seen the media spreading misinformation that this proposal is banning cigarettes and that it will result in a black market and “benefit cartels.” Misinformation and disinformation, including on social media, will be an ongoing issue for any public health efforts, including this one.

And there will likely be opposition from the Trump administration to capping the limit on nicotine. President Trump’s chief of staff, Susie Wiles, worked as a tobacco lobbyist while running his 2024 presidential campaign. Additionally, one of the platforms of the Trump administration is deregulation, stating that one of the first priorities is to “pause burdensome and radical regulations…” While nobody knows what will happen, the FDA’s final rule to ban menthol in cigarettes and flavors in cigars was withdrawn by Trump’s administration during his first week in office, which may be a harbinger of what is to come.

This proposed policy is a product standard, not a product ban. Thus, if implemented, cigarettes, cigars, and other similar products would remain on the market. However, they would contain nonaddictive levels of nicotine. Furthermore, this proposed product standard does not apply to lower-harm alternative tobacco/nicotine products (i.e., those that aren’t combusted), such as e-cigarettes and pouches, like Zyn. They would remain on the market at their normal nicotine levels, which could also help people alleviate potential withdrawal symptoms. This would separate nicotine delivery from the harmful effects of smoking.

Half a million smokers die prematurely each year. If this rule is finalized and implemented, it could be the most impactful public health policy of the century.

Jennifer Ross is an associate professor of health law, policy, and management at Boston University’s School of Public Health. Much of her work is focused on tobacco policy and regulation. She can be reached at jjross@bu.edu.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact today@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.