Reduction versus abrupt cessation in smokers who want quit

Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, West Midlands, UK, B15 2TT.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 03/2010; 3(3):CD008033. DOI: 10.1002/14651858.CD008033.pub2
Source: PubMed


The standard way to quit smoking is to smoke as normal until a quit day at which point the smoker stops using all cigarettes. Most smokers who try to quit end up relapsing, therefore there are a number of people who have tried to quit abruptly in the past without success, and are disillusioned with this approach. An alternative way to give up could be to reduce the amount of cigarettes smoked before going on to quit completely. There is evidence to suggest that reducing smoking before quitting would be popular with smokers. This means that offering this approach to quitting could encourage more smokers to give up, however before offering this approach it is important to ensure it is at least as successful as abrupt quitting. This is because given a choice smokers who would otherwise have quit abruptly may choose to reduce first instead. If reduction isn't as effective, smokers who choose that method will be at a disadvantage. The aim of this review was to compare quit rates in reduction to quit and abrupt quitting interventions to see if reducing to quit is at least as successful as abrupt quitting. Ten studies were found which compared reducing smoking before quitting with abrupt quitting. Pooled results found that neither reducing or abrupt quitting produced superior quit rates. This was true whether nicotine replacement therapy was used as part of the intervention or not, and whether participants were offered self-help materials or behavioural support. These results suggest that smokers should be given a choice of quitting methods, either reducing smoking before quitting or abrupt quitting, however, to inform the development of new interventions more research is needed into which method of reducing smoking is the most effective.

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    • "A last question addressed in this paper is concerned with the extent to which 'conflict about quitting' might account for the way that smokers approach their quit attempts, particularly whether they try to stop abruptly or by gradually reducing the amount they smoke. Evidence from randomised controlled trials appears to indicate that there is no difference in the likelihood of success as a function of whether one stops gradually or abruptly and this was independent of whether pharmacotherapy, self help therapy or behavioural support were included (Lindson et al., 2010). This suggests that more smokers could be led to try to quit with the help of behavioural support by permitting them to quit gradually if they wanted to. "
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    ABSTRACT: Background: Little is known about the extent to which smokers attending stop-smoking clinics experience conflicting motivations about their quit attempt, whether such conflict can be understood in terms of a single dimension and if this ‘conflict about quitting’ differs from motivation to stop smoking and is associated with a smoker's choice of method to stop smoking (stopping gradually or abruptly). Method: Sociodemographic, smoking and quit attempt characteristics as well as measures relating to conflict about stopping smoking were recorded in a cross-sectional survey of 198 smokers attending five quit smoking clinics in Malaysia. Results: Five measures (having seriously thought about quitting before, being happy about becoming a non-smoker, being strongly motivated to stop, intending to stop smoking completely and believing in stopping for good this time) were loaded onto a single factor that could be labelled ‘conflict about quitting’. The resultant scale had moderate internal reliability (Cronbach's α= .625). Most smokers exhibited conflicting motivations about stopping smoking, with over half (52.0%, 95% CI 45.1–59.1) scoring 2 or higher on the 5-point conflict scale. ‘Conflict about quitting’ was significantly associated with the decision to stop smoking gradually rather than abruptly controlling for other variables (OR 1.36, 95% CI 1.05–1.76) and was more strongly associated with the choice of smoking cessation method than motivation to stop smoking. Conclusions: ‘Conflict about quitting’ can be conceptualised as a single dimension and is prevalent among smokers voluntarily attending stop-smoking clinics. The finding that smokers who display greater conflict about quitting are more likely to choose gradual cessation may explain contradictory findings in the literature regarding the effectiveness of different methods of smoking cessation.
    The Journal of Smoking Cessation 06/2011; 6(01). DOI:10.1375/jsc.6.1.37
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    • "However, a review by Hughes [8] outlined the evidence collected to-date on these issues and concluded that attention to reduction as a smoking goal has value because there is evidence that reductions in smoking are positively associated with quit attempts in the future. Further, a recent Cochrane Systematic Review [10] concluded that there was support for the use of reduction goals as part of tobacco cessation interventions. "
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    ABSTRACT: Pre-cessation reduction is associated with quitting smoking. However, many smokers reduce the amount consumed but may not quit altogether. Using a representative sample of adult current daily smokers, this project explored future intentions of smokers regarding cigarette consumption. This information is important because it can provide a framework within which to plan tobacco cessation initiatives. A random digit dialing telephone survey was conducted of 889 Canadian current daily smokers, 18 years and older. The response rate was 65% (of households with a smoker in residence, 65% agreed to participate). Analyses focused on the 825 respondents who smoked at least 10 cigarettes per day at some point in their lives. As part of this survey, respondents were asked their future plans about their smoking (maintain, increase, reduce, quit). Of these 825 respondents, the majority of respondents had plans to change their cigarette use, with 55% planning to quit, 18.8% to reduce and 22.5% to maintain the amount they smoked (3.4% did not know and 2 respondents planned to increase). Most smokers who planned to reduce their smoking saw it as a step towards quitting smoking completely. These results present a picture of smokers, the majority of whom appear to be in some form of transition. Many smokers planned to reduce, of which the overwhelming majority saw their reduction as a step towards quitting. Opportunities exist to capitalize on these intentions to change in efforts to promote tobacco cessation.
    International Journal of Environmental Research and Public Health 07/2010; 7(7):2896-902. DOI:10.3390/ijerph7072896 · 2.06 Impact Factor
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    ABSTRACT: Potentially reduced exposure products (PREPs), already sold in USA and in some European Countries, are low-nitrosamine cigarettes, low-nitrosamine smokeless tobacco (e.g., the Swedish Snus), cigarette-like products, and medicinal nicotine products. Even e-cigarette delivers nicotine. With the exception of snus and medicinal nicotine, studies on the health effects of PREPs have not been carried out, although some PREPs are already sold and promoted as products that effectively reduce health risks. Thus, a second disaster similar to that occurred for light cigarettes could happen in the next years. Only medicinal nicotine and snus could be valid candidates to become PREPs, even if they pose some significant health risks. The World Health Organization, following a precautionary approach, has recently published a list of 9 carcinogens or toxicants recommended for mandated lowering (the tobacco-specific nitrosamines NNN and NNK, acetaldehyde, acrolein, benzene, benzo[a]pyrene, 1-3 butadiene, carbon monoxide, formaldehyde), and 9 carcinogens or toxicants for monitoring in usual cigarettes (not PREPs), underlining that tobacco companies cannot use this reduction strategy as a promotional message, as it occurred for light cigarettes in the 70s and 80s. The present status quo, in which cigarettes are freely available, medicinal nicotine, being a drug, is available under a regulated market, and Snus is prohibited, actually denies smokers the right to choose safer nicotine products. The solution suggested by the UK Royal College of Physicians is to balance the nicotine market, framing tobacco products and medicinal nicotine in the same regulation system; establishing a nicotine and tobacco regulatory authority;making medicinal nicotine more available; evaluating the feasibility of the introduction in the English market of Swedish Snus. California Government remarks that the nicotine maintenance is not a valid strategy, because it could induce smokers not to try to quit.Thus, California Department of Health Services prohibits promotion of snus and medicinal nicotine as a harm reduction strategy. However, the US Federal Family Smoking Prevention and Tobacco Control Act, signed by President Obama in 2009, places tobacco products under FDA jurisdiction: FDA must define criteria for lowering carcinogens and toxicants in tobacco products, making more available medicinal nicotine, evaluating PREPs, creating a federal Tobacco Control Agency.Which approaches is Italy going to follow?
    Epidemiologia e prevenzione 35(3-4 Suppl 1):19-32. · 0.78 Impact Factor
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