Cigarettes with Very-Low Nicotine Substitute for Typical Cigs Equally Well as Vapes

The study enrolled 209 adults who smoked cigarettes but were not ready to quit. Participants were randomly assigned to switch to one of three interventions.

It may be that a key to helping people avoid their cigarettes is using a product that mimics the hand-mouth experience of traditional cigarettes—regardless of the level of nicotine it delivers.

UW-CTRI researchers tested cigarettes with very low nicotine (VLNCs) as well as vaping devices and found that both were solid behavioral substitutes for cigarettes, reducing the number of cigarettes people smoked. Meanwhile, nicotine patches didn’t help people switch to one of these substitutes. The results were published in Nicotine & Tobacco Research.

“It may be that the behavioral aspect of the smoking experience is key,” said lead author Dr. Megan Piper, a UW-CTRI Research Director and principal investigator for the Options study.

The study enrolled 209 people in the Madison and Milwaukee areas who didn’t want to quit smoking and asked them to temporarily switch to either VLNCs or vapes. A third group didn’t get a substitute. During the two different “Switch Weeks” participants used an active nicotine patch or a placebo patch (and then used the other patch for the next Switch Week). People were asked not to smoke their own cigarettes during the Switch Weeks, but if they did smoke their own, they recorded how many they had smoked each day.


Janice saw an ad for the Options study on Facebook, met with UW-CTRI Health Counselor Chris Ripley, who helped randomize Janice to receive the Juul vape product plus the patch.

During the first week of the Options study, Janice was allowed to smoke, so she did. She had smoked a pack a day for years.

For the second week of the study, she used the vape device and nicotine patches.

“I haven’t had a cigarette since. I was amazed, in a week!”

“Many people use vaping as a cigarette substitute. We hypothesized that vapes would be a better substitute because it provides both nicotine as well as two behaviors—the hand-to-mouth and inhaling. We were surprised to see that VLNCs work just as well,” Piper said. “That’s exciting, because other research has shown that people who switch to VLNCs typically reduce their use of traditional cigarettes or quit all use.”

“When people are ready to quit smoking, there are many safe and effective treatments that can help, including calling 800-QUIT-NOW. These data suggest that adding in a behavioral substitute, like a VLNC, might be another helpful tool to tackling tobacco addiction.”

The Options study was made possible by a $1.4 million three-year grant from the National Cancer Institute and Food and Drug Administration to the University of Wisconsin Center for Tobacco Research and Intervention.

Piper ME, Schlam TR, Donny EC, Kobinsky K, Matthews J, Piasecki TM, Jorenby DE. The Impact of Three Alternate Nicotine-Delivery Products on Combusted Cigarette Use: A Randomized Controlled Trial. Nicotine & Tobacco Research.