Alternative products like vapes or cigarettes with very low levels of nicotine (VLNCs) seemed to help people with no intention of quitting smoking to avoid smoking their regular brand of cigs—not just during a trial switch week but even in the week thereafter.
These results, from the original Options Study led by UW-CTRI Director of Research Dr. Megan Piper, were recently published in Drug and Alcohol Dependence.
Participants in the study who had no intention to quit their regular brand of cigarettes were given either VLNCs or e-cigarettes for a week and instructed to see if they could avoid smoking their regular brand. Not only were they able to but, even in the week after when they were permitted to go back to their regular brand, many continued avoiding regular cigarettes.
“Instructed switching might spark motivation for behavior change that gathers some momentum,” said lead author and UW-CTRI Researcher Dr. Thomas Piasecki.
The switch week effect was significantly larger in the VLNC (a 35.9 percentage point increase in the probability of daily cigarette avoidance), and e-cigarette (31.2) groups compared to the no-product group (16.4).
“My clinical takeaway from these data is that an instructed period of experimentation with switching to lower-risk products could be a catalyst for modifying tobacco-related risk among adults who smoke and are not yet ready to quit,” Piasecki said.
Piper said the continued abstinence from their preferred brands was unprompted.
“The study team gave them no help with abstaining during the week after switching,” she said. “We saw them at the end of the switch week and again at the beginning of the second switch week, so there was no way we could have known (at the time) that they remained abstinent.”
The researchers said they were surprised that VLNCs were as good or better than vapes at helping people take a break from their usual brand, since vapes have more nicotine. They concluded that nicotine isn’t the sole or most critical characteristic of an effective substitute for usual-brand smoking; it could be that the sensory and behavioral experiences associated with smoking an actual cigarette are huge factors.
Which is healthier long-term?
Piasecki said longer-term switching trials comparing VLNCs and e-cigarettes are needed to more comprehensively evaluate the comparative health risks and benefits associated with these products.
“It would be interesting to try an extended switching trial (lasting, say, two to three months),” he said. “That would allow us to see how motivation for switching evolves over time and how own-cigarette abstinence plays out. Probably there would be a subset of participants who eventually get discouraged or disinterested and revert back to exclusive smoking. Another subgroup might gain momentum and confidence over time, completely or nearly completely replacing use of combusted cigarettes with alternative products. It would be interesting to determine the relative sizes of such subgroups and test whether they differ according to which alternative product they were assigned. If there is a subgroup who completely (or nearly completely) replaces combusted cigarettes with an alternative product, it would be interesting to determine the trajectories of long-term use of the alternative products. Do they keep using them or progress toward complete cessation of nicotine products?
“Another interesting study design might be to randomize some participants to a condition in which they can choose one or more alternative products to use as substitutes. Other participants might be assigned an alternative product without choice. Perhaps getting to choose a product that is most appealing would promote initial success in switching but lead to prolonged use of the alternate product. The choice condition in this kind of study would more closely resemble the real-world marketplace conditions for smokers interested in trying to find a cigarette substitute.”
A manageable task?
Piasecki said it may be that “quitting smoking forever” seems like a daunting task, but “trying to switch products for a week” seems more manageable, and giving that a try and succeeding could be a secret sauce for building confidence for quitting longer later.
Researchers also found that nicotine patches promoted cigarette substitution, but only when provided early in the switching process.
Piasecki TM, Slutske WS, Bolt DM, Jorenby DE, Piper ME. (2025) Effects of Very Low Nicotine Cigarettes, E-Cigarettes, and Nicotine Patches on Daily Own-Cigarette Abstinence in a Randomized Controlled Switching Trial. Drug and Alcohol Dependence. Online January 31, 2025.