BACKGROUND: Reduced nicotine content (RNC) cigarettes have led to smoking fewer 
cigarettes, withdrawal relief, and facilitation of cessation. The aim of this 
study is to examine the effects RNC cigarettes with and without nicotine patch 
and patch alone on smoking behavior, toxicant exposure, withdrawal discomfort, 
and as an exploratory analysis, on long-term abstinence.
METHODS: This study involved a randomized, parallel arm design and six weeks of: 
(i) 0.05-0.09 mg nicotine yield cigarettes (N = 79); (ii) 21 mg nicotine patch 
(N = 80), or (iii) 0.05-0.09 nicotine yield cigarettes with 21 mg nicotine patch 
(N = 76); all groups received six weeks of additional behavioral treatment with 
follow-ups up to six months.
RESULTS: Combination approach led to lower rates of smoking assigned cigarettes 
and hence lower carbon monoxide levels than RNC cigarettes alone. In addition, 
the combination approach was associated with less withdrawal severity when 
switching from usual brand to assigned product, and less smoking of usual brand 
cigarettes during treatment, but not after treatment compared with the other 
approaches.
CONCLUSION: Combining very low nicotine content cigarettes with nicotine patch 
may improve the acute effects resulting from switching to either of these 
products alone.
IMPACT: These findings may have implications for smoking cessation treatment or 
a policy measure to reduce nicotine content in cigarettes.