Public Health and Levels of Nicotine: Should Nicotine Levels in Cigarettes Be Minimized or Maximized?

In the early 1970s, it was already evident that nicotine dependence was the major factor underlying the maintenance of smoking (1); it was also clear that smokers unconsciously regulate their nicotine intake by reducing puff rate when smoking a high-nicotine cigarette and by increasing it to compensate for the drop in yield when smoking a low-nicotine cigarette (2-5). Confirmation of this self-regulation of nicotine intake, using carboxyhemoglobin (COHb) as a marker of inhalation, exposed the limitations of low-tar, low-nicotine cigarettes, as recommended in official national policies, and led us to suggest that the least harmful cigarettes for heavy smokers might be those with low tar and CO yields but a high, rather than low, nicotine yield (6,7). But, since it is also desirable to keep nicotine intake as low as possible, this was later modified to a "low-tar medium-nicotine" (LTMN) approach to safer smoking (8,9).