Quitting by Gradual Smoking Reduction Using Nicotine Gum A Randomized Controlled Trial

ArticleinAmerican journal of preventive medicine 36(2):96-104.e1 · March 2009with15 Reads
DOI: 10.1016/j.amepre.2008.09.039 · Source: PubMed
Many smokers express a desire to quit smoking by gradually reducing the number of cigarettes they smoke until they stop completely. This study tested the efficacy of nicotine gum in facilitating cessation through gradual reduction. This was a multi-center, placebo-controlled, double-blind RCT of 2- and 4-mg nicotine gum versus placebo. 3297 smokers who were interested in quitting gradually. Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided. Continuous abstinence was assessed after 28 days and 6 months. Secondary measures of smoking reduction were also assessed. Analyses were conducted in 1999-2000 and 2007-2008. Smokers on active gum were significantly more likely to achieve initial cessation (2 mg: OR=1.42; 4 mg: OR=1.90); 28-day continuous abstinence (2 mg: OR=2.01; 4 mg: OR=4.66); and continuous abstinence at 6 months (2 mg: OR=1.80; 4 mg: OR=5.96). During the reduction phase, active gum aided smoking reduction, and participants who reduced their smoking were more likely to achieve abstinence. These findings demonstrate that smokers who wish to quit smoking by gradual reduction can increase their success by using nicotine gum to facilitate reduction and cessation.
    • "While traditional cessation strategies (e.g., motivational interviewing, stage-matched intervention) might not help some smokers to achieve cessation, reduction is appealing because making progression towards the goal of complete cessation reflects visible behavioral change (Carpenter et al., 2004 ). Experimental studies have found that smoking reduction intervention combining medication and counseling is effective for smokers without intention to quit (Asfar et al., 2011; Batra et al., 2005; Bolliger et al., 2000; Carpenter et al., 2004; Chan et al., 2011; Rennard et al., 2006; Shiffman et al., 2009; Wennike et al., 2003), but it is not clear whether the increase in quitting is due to NRT availability, reduction itself , or both (Asfar et al., 2011). Although a few studies have found the dose–response effect between reduction quantity and later abstinence (Broms et al., 2008; Falba et al., 2004; Farkas, 1999; Hughes et al., 2004 ), these studies arbitrarily categorized reduction quantity and assumed a few thresholds of reduction for cessation. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: We examined how quantity and trajectory of smoking reduction influence later abstinence in smokers without intention to quit and being prescribed free nicotine replacement therapy (NRT). Method: We conducted an a posteriori analysis from a data archive of adult smokers in a randomized controlled trial of smoking reduction using counseling and free NRT (n = 928). Reduction was analyzed as the absolute and percentage decrease in self-reported daily cigarette consumption at three follow-ups (1 week, 1 and 3 months) compared with the baseline. Logistic regression model and multiple imputation were used to examine the association between early reduction and abstinence at 6 months. Results: Reducing 10% of cigarette consumption at the three follow-ups was associated with 16% (95% CI 5-28%), 23% (95%CI 11-36%) and 27% (95% CI 13-42%) increase in abstinence, respectively. Greater reduction predicted abstinence when the percentage reduction was more than one-third (above 31.4%). Progressive increase in the percentage reduction predicted more abstinence (OR = 1.90, 95%CI 1.01-3.58). Conclusions: Greater percentage reduction by at least one-third and progressive reduction predicted abstinence in those who reduced smoking. Such new evidence can guide the improvement of clinical service for tobacco dependency treatment and support further studies on smoking reduction and cessation.
    Full-text · Article · Dec 2015
    • "In this RCT, the smokers without quit attempt experience might be more empowered and encouraged to quit with the alternative approach of smoking reduction, as they did not want to achieve cessation through abrupt cessation. Several studies have found that smoking reduction intervention with NRT and counseling are effective to help smokers without quitting intention [12,15,16,18,272829. "
    [Show abstract] [Hide abstract] ABSTRACT: The prevalence and correlates of hardcore smokers, who have high daily cigarette consumption, no quitting history and no intention to quit, have been studied in several western developed countries, but no previous trials of smoking cessation have tested intervention effectiveness for these smokers. The current study examined if hardcore smokers can benefit from smoking reduction intervention to achieve cessation, and explored the underlying reasons. A posteriori analysis was conducted on data from a randomized controlled trial of smoking reduction intervention on 1,154 smokers who did not want to quit. Odds ratios of 7-day point prevalence of abstinence, smoking reduction by at least 50% and quit attempt at the 6-month follow-up comparing subgroups of smokers were analyzed. In hardcore smokers, the odds ratio comparing the quit rate between the intervention and control group was 4.18 (95% CI: 0.51-34.65), which was greater than non-hardcore smokers (OR = 1.58, 95% CI: 0.98-2.54). The number needed to treat for hardcore and non-hardcore smokers was 8.33 (95% CI: 5.56-16.67) and 16.67 (95% CI: 8.33-233.64), respectively. In smokers who did not have quit attempt experience and those who smoked more than 15 cigarettes daily, the odds ratio comparing intervention and control group was 3.29 (95% CI: 0.72-14.98) and 1.36 (95% CI: 0.78-2.36), respectively. The a posteriori analysis provided pilot results that smoking reduction intervention may be effective to help hardcore smokers to quit and reduce smoking. Having no previous quit attempt was identified as more important than having large cigarette consumption in explaining the greater effectiveness of the intervention.
    Full-text · Article · Apr 2015
    • "There is a huge literature on cessation strategies. Gradual cessation and abrupt cessation strategies are compared in [14] and [15]. These cessation strategies can be evaluated using model (4abc). "
    Dataset · Sep 2014 · Tobacco Induced Diseases
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