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Correspondence to Dr Lisa Henriksen, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California 94305, USA; [email protected]
WHAT IS ALREADY KNOWN ON THIS TOPIC
The first combustible cigarettes to be authorised by the Food and Drug Administration (FDA) as a modified risk tobacco product are being test marketed in the USA.
WHAT THIS STUDY ADDS
VLN has minimal presence in power walls among high-nicotine cigarettes. To offset premium pricing, VLN advertises discounts, coupons and a sweepstakes offer, and co-branding with a store membership app. Not all VLN marketing claims were authorised by FDA, which raises concerns about compliance with FDA authorisation.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Adherence to FDA-authorised marketing claims should be monitored. Consumer surveys in VLN test markets are needed to describe reasons for product trial, characterise early adopters and evaluate motives for discontinuation. In addition, research is needed to evaluate risk perceptions, especially for menthol VLN, given FDA consideration of an exemption for VLN from the menthol cigarette rule.
Introduction
People do not start smoking cigarettes to become addicted, and 7 in 10 people who smoke want to quit.1 Most commercial cigarettes are designed with high levels of nicotine that create and sustain addiction, compelling repeated dosing within a day and chronic use over time with exposure to harmful toxins.2 Fewer than a third of people who try to quit use cessation medications, and the quit failure rate exceeds 90%.1
Low-nicotine cigarettes aim to minimise addiction liability by reducing the amount of nicotine in the rod, potentially by over 90%. They are distinct from cigarettes marketed as ‘light’ or ‘ultralight’, which as designed enabled compensation and delivered similar levels of nicotine as other cigarettes.2 The tobacco industry has been capable of reducing nicotine in cigarettes for decades. By the early 1970s, RJ Reynolds and Philip Morris knew of a market for low-nicotine cigarettes, especially ‘for smokers who want to quit’.3 A 1987 Philip Morris analysis identified this market as having the highest potential for growth, with concern for a ‘less enjoyable product which will be easier to give up, and finally quit’.3 Philip Morris estimated the potential market share of a free-standing denicotinised cigarette brand at 1.5%–2.0% or...