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Nicotine is the major addictive agent in tobacco and cigarette smoke, and its levels are important in defining the abuse liability of tobacco products.32,33 Acknowledging its central role in driving tobacco use (and as a consequence, the associated morbidity and mortality), substantial reduction of nicotine content in cigarettes is being considered by the US Food and Drug Administration (FDA) as an approach to reduce the addictiveness and eventually eliminate the use of combusted tobacco products.34,35 Besides its addictive properties, nicotine also stimulates the sympathetic nervous system, decreases coronary blood flow, and induces other pharmacological effects that can contribute to cardiovascular events in tobacco users.36 The high levels of nicotine in the tobacco filler of NAS brands (Table 6) indicate that tobacco type, in addition to the greater mass of tobacco per cigarette rod, contributes to the high levels of nicotine in the smoke of these cigarettes

Looking forward, if the number of packs sold drops as the city expects to 41.6 million, the per capita rate would be 27.7 packs per year per person

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doi: 10.1136/bmj.39227.409641.AD

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